ER² risk stratification for short-term age-related adverse emergency room events


Since 2012, we have been perfecting and validating a simple clinical tool, known as the “6-item brief geriatric assessment” (BGA), which is used to screen older ER users at risk of short and medium terms age-related adverse ER outcomes. The 6-item BGA provides risk stratification in three levels (i.e., low, moderate and high), to help predict short-term agerelated adverse ER outcomes (i.e., long ER and hospital stays, hospital mortality). The main difference with other ER screening tools is that we introduced weighting for two items, exploring cognition and mobility, now scored for 5 points instead of 1, because as we have demonstrated that these items are key risk factors for short-term age-related adverse ER outcomes. Recently, we have improved the 6-item BGA by adding an interventional facet to the assessment component. Interventional suggestions depend on the results of the assessment component, and feature recommended interventions aiming to prevent confusion, motor deconditioning, adverse drug reactions and inappropriate home support. These recommendations are formulated with the help of the answers to the 6-item BGA. Because of this change, the 6-item BGA is now known as the “Emergency Room Evaluation and Recommendations,” or ER². ER² risk stratification has never been associated with any incident age-related short-term adverse ER events in Quebec.


  • To examine how the three levels of ER² stratification related with incident age-related short-term adverse ER events in older users


ER² risk levels have correlated with LOS in ER and in hospital, as well as with hospital admission rates. The ER² tool is predictive.


Faculty of Medicine, McGill University

Emergency Department, Jewish General Hospital