Geriatric Screening, Triage Urgency, and 30‐Day Mortality in Older Emergency Department Patients
Open Access
- 4 April 2020
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 68 (8), 1755-1762
- https://doi.org/10.1111/jgs.16427
Abstract
BACKGROUND Urgency triage in the emergency department (ED) is important for early identification of potentially lethal conditions and extensive resource utilization. However, in older patients, urgency triage systems could be improved by taking geriatric vulnerability into account. We investigated the association of geriatric vulnerability screening in addition to triage urgency levels with 30‐day mortality in older ED patients. DESIGN Secondary analysis of the observational multicenter Acutely Presenting Older Patient (APOP) study. SETTING EDs within four Dutch hospitals. PARTICIPANTS Consecutive patients, aged 70 years or older, who were prospectively included. MEASUREMENTS Patients were triaged using the Manchester Triage System (MTS). In addition, the APOP screener was used as a geriatric screening tool. The primary outcome was 30‐day mortality. Comparison was made between mortality within the geriatric high‐ and low‐risk screened patients in every urgency triage category. We calculated the difference in explained variance of mortality by adding the geriatric screener (APOP) to triage urgency (MTS) by calculating Nagelkerke R2. RESULTS We included 2,608 patients with a median age of 79 (interquartile range = 74‐84) years, of whom 521 (20.0%) patients were categorized as high risk according to geriatric screening. Patients were triaged on urgency as standard (27.2%), urgent (58.5%), and very urgent (14.3%). In total, 132 (5.1%) patients were deceased within a period of 30 days. Within every urgency triage category, 30‐day mortality was threefold higher in geriatric high‐risk compared to low‐risk patients (overall = 11.7% vs 3.4%; P < .001). The explained variance of 30‐day mortality with triage urgency was 1.0% and increased to 6.3% by adding the geriatric screener. CONCLUSION Combining triage urgency with geriatric screening has the potential to improve triage, which may help clinicians to deliver early appropriate care to older ED patients.Funding Information
- ZonMw (627003001, 627004001)
This publication has 42 references indexed in Scilit:
- Adverse outcomes in older adults attending emergency departmentEuropean Journal of Emergency Medicine, 2013
- At Risk of Undertriage? Testing the Performance and Accuracy of the Emergency Severity Index in Older Emergency Department PatientsAnnals of Emergency Medicine, 2012
- The Manchester triage system: improvements for paediatric emergency careEmergency Medicine Journal, 2012
- Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific EvidenceScandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2011
- Older Patients in the Emergency Department: A ReviewAnnals of Emergency Medicine, 2010
- Accuracy of the Emergency Severity Index Triage Instrument for Identifying Elder Emergency Department Patients Receiving an Immediate Life‐saving InterventionAcademic Emergency Medicine, 2010
- Emergency department triage revisitedEmergency Medicine Journal, 2010
- Emergency Department Triage of Acute Myocardial Infarction Patients and the Effect on OutcomesAnnals of Emergency Medicine, 2009
- Reliability and validity of the Manchester Triage System in a general emergency department patient population in the Netherlands: results of a simulation studyEmergency Medicine Journal, 2008
- Studies of Illness in the AgedJAMA, 1963