Triage tools: a cautious (and critical) view towards their use in old patients

Puig, Mireia; Blázquez-Andión, Marta; Ris-Romeu, Josep

doi:10.1007/s41999-021-00572-7

Cited by 5 publications

(6 citation statements)

References 44 publications

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“…Somos conscientes de que estas escalas de fragilidad, de manera aislada, pueden ser insuficientes. Pero sirven para identificar al paciente frágil o de mayor riesgo que más se beneficiaría de una VGU, la cual, es la herramienta de referencia para identificar problemas concretos sobre los que intervenir [3][4][5][6][7][8][9][10]30 .…”

Section: Discussionunclassified

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Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments

Fernández Alonso,

Del Arco Galán,

Torres Garate

et al. 2024

Emergencias

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Objetivo. Comparar la capacidad de tres escalas de fragilidad, Clinical Frailty Scale (CFS), Functional Index – eMergency (FIM) e Identification Senior at Risk (ISAR), para predecir resultados adversos (RA) a 30 días en los pacientes mayores dados de alta desde el servicio de urgencias hospitalario (SUH). Método. Análisis secundario del registro FRAIL-Madrid que incluyó pacientes $ 75 años dados de alta de 10 SUH de Madrid durante un periodo de 3 meses entre 2018 y 2019. Se definió fragilidad como CFS $ 4, FIM $ 2 e ISAR $ 3. Las variables de resultado fueron revisita en urgencias, hospitalización, deterioro funcional, muerte y la variable compuesta por algún RA de los anteriores en los 30 días posteriores al alta del SUH. Resultados. Se incluyeron 619 pacientes, la edad media fue de 84 años (DE 7), 59,1% eran mujeres. Hubo 339 pacientes (54,8%) identificados como frágiles en el SUH según CFS $ 4, 386 (62,4%) según FIM $ 2 y 301 (48,6%) según ISAR $ 3. Hubo 226 pacientes (36,5%) que presentaron algún RA a los 30 días tras el alta (21,5% revisita, 12,6% hospitalización, 18,4% deterioro funcional y 3,6% muerte). El área bajo la curva (ABC) de la escala CFS fue de 0,66 (0,62-0,70; p = 0,022), de FIM 0,67 (0,62-0,71; p = 0,021) y de ISAR 0,64 (0,60-0,69; p = 0,023). La presencia de fragilidad fue un factor independiente de presentar algún RA a los 30 días tras el alta (CFS $ 4 ORa 3,18 [IC 95% 2,02-5,01, p < 0,001], FIM $ 2 ORa 3,49 [IC 95% 2,15-5,66, p < 0,001] e ISAR $ 3 ORa 2,46 [IC 95% 1,60-3,79, p < 0,001]). Conclusiones. Las tres escalas estudiadas –CFS, FIM, ISAR– son útiles y tienen una capacidad similar para identificar al paciente mayor frágil dado de alta del SUH con alto riesgo de presentar RA (muerte, deterioro funcional, hospitalización o revisita al SUH) a los 30 días.

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Section: Discussionunclassified

“…Es decir, un estado con alto riesgo de presentar resultados adversos (RA) ante un factor desencadenante. No obstante, no existe una definición unánime de fragilidad ni una herramienta que pueda ser considerada de referencia [8][9][10] . En la actualidad, existe una aproximación centrada en el rendimiento físico 11 y otra multidimensional 12,13 .…”

Section: Introductionunclassified

Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments

Fernández Alonso,

Del Arco Galán,

Torres Garate

et al. 2024

Emergencias

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“…Patients who do not wait but require urgent care, have been shown to have an increased need for admission and increased risk of death on re‐presentation 31 . Furthermore, older adults are particularly vulnerable and often under‐triaged, 32 which leads to further increased wait times and decreased timely recognition of acutely unwell patients 32 . It is thus imperative that efforts are made to minimise this vulnerable group of patients leaving before they are seen.…”

Section: Discussionmentioning

confidence: 99%

“…31 Furthermore, older adults are particularly vulnerable and often undertriaged, 32 which leads to further increased wait times and decreased timely recognition of acutely unwell patients. 32 It is thus imperative that efforts are made to minimise this vulnerable group of patients leaving before they are seen. Rates highlighted in red represent a decrease in rates, whereas those in black are an increase.…”

Section: Did Not Waitmentioning

confidence: 99%

Impact of COVID‐19 state‐wide lockdown on older adult presentations to Queensland emergency departments

Eccleston

Marsden

Craswell

et al. 2023

Emerg Medicine Australasia

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ObjectiveTo determine the impact of the COVID‐19 state‐wide lockdown on ED presentations for older adults in Queensland, Australia.MethodsA retrospective cohort study pertaining to adults aged 70+ years who presented to Queensland public hospital EDs across three separate time periods; 11 March to 30 June 2018 and 2019 (pre‐pandemic average), 2020 (COVID‐19 state‐wide lockdown) and 2021 (post‐state‐wide lockdown). The primary outcome was change in presentation rates to ED. Secondary outcomes included change in triage category rates, length of stay (LOS), diagnosis and disposition.ResultsThere was 380 854 older adult presentations. During the COVID‐19 state‐wide lockdown, ED presentation rates decreased by 12.5% (incidence rate ratio 0.875 [95% confidence interval 0.867–0.883]). All triage category presentation rates decreased, as did ED LOS and reasons for presentation, except sepsis and disorders of the nervous system. In the post‐state‐wide lockdown period a 22% (incidence rate ratio 1.22 [95% confidence interval 1.21–1.23]) increase in the presentation rate was observed and presentations in all triage categories increased. ED LOS increased to longer than pre‐pandemic (P < 0.001). Respiratory presentations increased by 346%. Patients who ‘did not wait’ increased by 212% and ED mortality rose by 42% compared to during the lockdown.ConclusionThere was a significant decrease in presentation rates to EDs during the COVID‐19 state‐wide lockdown for the older population, followed by an increase in presentation rates, longer ED LOS, and an increased ED mortality rate, in the post‐state‐wide lockdown period. It is important to ensure older adults continue to seek appropriate, timely medical care, during a pandemic.

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“…The world population is aging rapidly, and the number of older emergency department (ED) patients is increasing [ 1 – 3 ]; however, acuity assessment for older adults remains an unsolved challenge [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Emergency Severity Index in older adults

Kemp

Alakare

Kätkä

et al. 2022

European Journal of Emergency Medicine

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Background and importance Emergency Severity Index is a five-level triage tool in the emergency department that predicts the need for emergency department resources and the degree of emergency. However, it is unknown whether this is valid in patients aged greater than or equal to 65 years. Objective The aim of the study was to compare the accuracy of the Emergency Severity Index triage system between emergency department patients aged 18–64 and greater than or equal to 65 years. Design, settings, and participants This was a retrospective observational cohort study of adults who presented to a Finnish emergency department between 1 February 2018 and 28 February 2018. All data were collected from electronic health records. Outcome measures and analysis The primary outcome was 3-day mortality. The secondary outcomes were 30-day mortality, hospital admission, high dependency unit or ICU admission, and emergency department length of stay. The area under the receiver operating characteristic curve and cutoff performances were used to investigate significant associations between triage categories and outcomes. The results of the two age groups were compared. Main results There were 3141 emergency department patients aged 18–64 years and 2370 patients aged greater than or equal to 65 years. The 3-day mortality area under the curve in patients aged greater than or equal to 65 years was greater than that in patients aged 18–64 years. The Emergency Severity Index was associated with high dependency unit/ICU admissions in both groups, with moderate sensitivity [18–64 years: 61.8% (50.9–71.9%); greater than or equal to 65 years: 73.3% (63.5–81.6%)] and high specificity [18–64 years: 93.0% (92.0–93.8%); greater than or equal to 65 years: 90.9% (90.0–92.1%)]. The sensitivity was high and specificity was low for 30-day mortality and hospital admission in both age groups. The emergency department length of stay was the longest in Emergency Severity Index category 3 for both age groups. There was no significant difference in accuracy between age groups for any outcome. Conclusion Emergency Severity Index performed well in predicting high dependency unit/ICU admission rates for both 18–64 years and greater than or equal to 65-year-old patients. It predicted the 3-day mortality for patients aged greater than or equal to 65 years with high accuracy. It was inaccurate in predicting 30-day mortality and hospital admission for both age groups.

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Triage tools: a cautious (and critical) view towards their use in old patients

Cited by 5 publications

References 44 publications

Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments

Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments

Impact of COVID‐19 state‐wide lockdown on older adult presentations to Queensland emergency departments

Accuracy of Emergency Severity Index in older adults

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