Risk stratification tool for older emergency department patients: the 6-items brief geriatric assessment

Older patients are increasingly presenting to Emergency Departments (EDs) and therefore, outcome prediction tools are important to provide adequate care. The study aimed to explore the value of the 6-item brief geriatric assessment (BGA) as a rapid screening tool for identifying the potential risk of adverse outcomes in older patients.

This was an observational prospective cohort study, conducted in 36 European EDs and included patients aged 65 years and older with any complaint for seven consecutive days. The 6-item BGA was performed at admission and classified the population into three levels of risk (low (LR), moderate (MR) or high (HR)). Generalised linear mixed models were used to assess the association of end points (admission, length of stay (LOS) and death) and BGA risk groups.

Among 4657 patients, 48% were men and the median age was 77 years. The association of ward admission was similar in BGA LR and MR groups but higher in the HR group (risk ratio RR = 1.22 [95%-confidence interval (CI) 1.13-1.31]). Compared to the LR group, the hospital LOS was similar in MR but higher in the HR group with a LOS ratio at 1.31 [95%-CI 1.20-1.42]. Mortality was higher in the MR and HR groups with RR = 2.02 [95%-CI 1.20-2.83] and 3.12 [95%-CI 2.47-3.77] respectively.

The study showed that higher BGA risk levels were associated with adverse outcomes in older ED patients. The 6-item BGA may help support rapid risk stratification and complement existing ED triage systems for identifying frailer patients. Further prospective studies are needed before routine implementation.

The study was registered with the U.S. National Library of Medicine Clinical Trials (trial number NCT04680299; registration date: 2020-12-22).