Predictive validity of the identification of seniors at risk (ISAR) screening tool in a Turkish emergency department

BACKGROUND: Emergency departments are increasingly managing older patients who frequently present with multimorbidity and functional decline, placing them at increased risk for short and long-term adverse outcomes. Early identification of patients at increased risk is essential for appropriate risk stratification and care planning. The Identification of Seniors at Risk (ISAR) is a brief screening tool developed to identify older emergency department patients at risk of adverse outcomes; however, its predictive performance has not been formally evaluated in the Turkish emergency department setting. This study aimed to evaluate the predictive validity and reliability of the Turkish version of ISAR among older ED patients. METHODS: This prospective cohort study included patients aged ≥ 65 years presenting to a tertiary level emergency department in Türkiye. The ISAR tool was translated using a forward-backward translation process and administered at index ED presentation. Adverse outcomes were assessed at 30 and 180 days and included death, unplanned hospitalization, functional decline, or transfer to a nursing home. Predictive performance was evaluated using receiver operating characteristic (ROC) analysis, and the optimal ISAR cut-off was determined based on ROC analyses. RESULTS: Among 356 included patients (median age:73 years), 54.5% were classified as high-risk (ISAR ≥ 2). High-risk status was significantly associated with advancing age, higher comorbidity burden, greater triage severity, longer ED stays and higher rates of hospital admission. At 30 days, ISAR demonstrated good predictive performance for the composite adverse outcome, with an area under the curve (AUC) of 0.790 (95% CI 0.741–0.838). Using a cut-off of ISAR ≥ 2, sensitivity was 89.3% and specificity was 61.7%. At 180 days, predictive performance remained robust, with an AUC of 0.818 (95% CI 0.772–0.864), sensitivity of 80.6%, and specificity of 71.1%. Inclusion of emergency department readmissions in the composite outcome resulted in lower sensitivity and higher specificity at both time points. CONCLUSIONS: The Turkish version of the ISAR screening tool demonstrated acceptable predictive validity for identifying older emergency department patients at risk of adverse outcomes, with consistently high sensitivity and moderate specificity. ISAR may be useful as a rapid risk stratification tool in the emergency department but should not be used as a standalone instrument for clinical decision-making.