背景：台灣面臨高齡化社會的挑戰，預測2025年將步入超高齡國家之列。65歲以上高齡人口比例不斷上升，由於高齡者常伴隨多重健康問題，使得急診醫療團隊面臨更多且複雜的挑戰。然而，現有的檢傷分類模型，無法準確評估高齡者疾病嚴重程度，突顯急需開發一個適用於高齡者的急診高危險篩檢工具，以更精確地評估高齡者健康狀況和風險，並及早發現潛在的健康問題並介入，以降低負向結果的發生。然而，2023年已發展台灣急診高齡者高危險篩檢工具(Taiwan Seniors at Risk, TSAR)，缺乏信效度檢測。
研究目的：本研究目的為驗證台灣急診高齡者高危險篩檢工具(TSAR) 之信效度。
研究方法：採前瞻性世代研究設計，於南部雙醫學中心急診分別招募65 歲以上、意識清楚可使用國/台語進行溝通、且急診檢傷分類為二、三、四或五級者。排除條件為疾病末期需安寧療護、長期臥床完全失能、收案時為72小時內急診或住院再返、因精神疾病診斷就醫者、轉入加護病房治療、車禍機轉入院者、及無法完整回答問卷者。以結構式問卷於入急診時進行資料收集，包括基本資料問卷、台灣五級檢傷與急迫度量表(TTAS)、台灣急診高齡者高危險篩檢工具(TSAR)、高齡者高危險識別篩檢量表(ISAR)、察爾森共病症指標(CCI)、臨床衰弱評估量表(CFS)、修改版Katz日常生活活動功能量表(Katz Activities of Daily Living Scale, Katz ADL)。後續追蹤其離開急診第三天及第三十天之負向結果，包括再返急診、入住機構、再住院、死亡及功能下降。資料分析以JASP套裝軟體以及R語言軟體進行分析，信度部分以項目間內在一致性進行檢定。效度部分以斯皮爾曼相關係數進行ISAR與TSAR分數之效標關聯效度；再者，探索性因素分析測試TSAR之建構效度；最後，以邏輯斯回歸，測試TSAR於預測高齡者發生負向結果之能力。並計算TSAR敏感度、特異性、ROC曲線等結果選擇出最適切截點。
研究結果：總計605位急診高齡者進行分析，但3天內發生負向結果僅215人進行分析，其中53人 (25.4%) 發生負向結果；其中，再返急診者48人 (23%)、再住院10人 (4.8%)、死亡1人 (0.4%)。605位高齡者中，404人完成一個月的追蹤，30天內發生負向結果者有231人 (57.1%)；其中，再返急診87人 (22%)、入住機構8人 (2%)、再住院153人 (38%)、死亡19人 (4.7%)、功能下降66人 (17%)。使用邏輯斯回歸分析顯示，TSAR得分與3天內與30天內的負向結果顯著相關，TSAR再切截點設為兩分時具有最高敏感性及陰性預測值，表明該工具在內能有效預測高齡者的健康風險。3天內負向結果預測敏感性為81.1%，特異性為42.6%，陰性預測值為86.8%，曲線下面積(AUC)為0.62(95% CI: 0.54-0.70)、3天內再返急診敏感性為81.3%、特異性為41.9%、陰性預測值為88.2%，曲線下面積為0.63(95% CI:0.54-0.71)。返家後30天內負向結果預測敏感性78.4%，特異性50.9%，陽性預測值為68%，陰性預測值為63.8%，曲線下面積(AUC)為0.72(95% CI: 0.67-0.77)、再返急診為敏感性為81.6%、特異性為39.7%、陽性預測值為27.8%、陰性預測值為88.3%，曲線下面積為0.70(95% CI:0.63-0.71)、再住院敏感性為76.5%、特異性為42.6%、陽性預測值為46.2%、陰性預測值為73.7%曲線下面積為0.64(95% CI:0.59-0.70)、死亡敏感性為94.7%、特異性為35.5%、陽性預測值為6.9%、陰性預測值為99.3%，曲線下面積為0.68(95% CI:0.58-0.79)、功能下降敏感性為87.9%、特異性為40.4%、陽性預測值為23.8%、陰性預測值為94%，曲線下面積為0.70(95% CI:0.63-0.78)。建構效度方面，探索性因素分析KMO取樣適切性測試值為0.72，Bartlett球形檢定的p值小於0.001，TSAR的五個構面(日常生活活動功能、認知功能、多重用藥、跌倒、住院史)能夠合理地解釋高齡者健康狀況的變異，總解釋變異量為24.6%。TSAR和ISAR量表兩者校標關聯效度斯皮爾曼等級相關係數達0.691(p < .001)，具有良好的校標關聯效度。信度檢定結果顯示，TSAR具有良好的內部一致性(McDonald's ω為0.65，Cronbach's α為0.61)，表明該工具的測量結果具有穩定性和一致性。
結論： TSAR具備良好的信度和效度，是一個適用且有效的篩檢工具，於預測效度的表現與其他國外急診高齡者篩檢工具如ISAR相似，但更適合台灣的醫療環境和文化背景。TSAR作為一個多面向的篩檢工具，不僅能幫助急診醫療團隊早期識別高危險高齡者，還能使醫療團隊了解高齡者存在的健康問題，提供相應的醫療轉介和介入措施，以降低負向結果的發生，從而改善高齡者的生活品質。

The study addresses Taiwan's aging society challenges by using the Taiwan Seniors at Risk (TSAR) tool for high-risk elderly patients in emergency departments. A prospective cohort study recruited 605 elderly patients from two medical centers in southern Taiwan. Eligibility criteria included being 65 years or older and conscious. Follow-up evaluations were conducted on the third and thirtieth days after emergency department visits to assess adverse outcomes. When the TSAR cutoff was set at 2 points, for predicting adverse outcomes within three days, TSAR demonstrated a sensitivity of 81.1% and a negative predictive value of 86.8%, with an area under the curve (AUC) of 0.62. For 30-day outcomes, the sensitivity was 78.4%, the negative predictive value was 63.8%, and the AUC was 0.72. Exploratory factor analysis confirmed TSAR's construct validity, with its five dimensions effectively explaining the variance in elderly health status, the total explained variance is 24.6%. TSAR showed good internal consistency, with McDonald's ω of 0.65 and Cronbach's α of 0.61, indicating stable and consistent measurements. In conclusion, TSAR is a reliable and valid tool, suitable for Taiwan's medical environment.

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