(1372) Individualized Prediction of Critical Illness in Older Adults

Introduction: The widespread adoption of the electronic health record (EHR) provides opportunities for timely identification of community-dwelling older patients at high risk of critical illness and for the development and implementation of potential preventive strategies. The objective of this study was to validate the performance of an EHR-based Elderly Risk Assessment (ERA) score designed to identify older patients at high risk for critical illness (defined as an illness leading to an ICU admission or death) during a routine primary care visit and identify optimal score thresholds for deployment of preventive strategies.

Methods: Population-based historical cohort study of patients ≥65 years old, who had primary care visits at Mayo Clinic Rochester, MN, between July 2019 and December 2021. The predictor variable was ERA score at time of primary care visit. The outcome was a combined outcome measure of death or ICU admission within one year of the primary care visit.

Results: Of the 14,241 patients who were seen by their primary care provider during the study period, 13,224 had provided authorization for use their medical records for research purposes and were included in the study. Median (IQR) age at time of primary care visit was 74.5 (69.0, 82.3) years, and 44.9% were male. Most participants (93.6%) were white, 64.4% were married, and the median Charlson comorbidity index was 5 (4, 8). The median ERA score at time of primary care visit was 4 (0, 9). 11.1% of study participants were admitted to the ICU or died within 1 year after visit. ERA score was found highly predictive of death or ICU admission within 1 year after a primary care visit with a receiver operating characteristic curve (AUC) of 0.84. An ERA score threshold of 9 was chosen as optimal for the deployment of preventive interventions for those age ≥65 years (sensitivity 0.75, specificity 0.79).

Conclusions: This EHR-based ERA score can predict critical illness within one year of a primary care visit in older patients. The findings of this study can serve as a basis for implementation of the ERA score in primary care and the development of strategies that may prevent critical illness in high-risk community-dwelling older adults.