Using mobility status as a frailty indicator to improve the accuracy of a computerised five-level triage system among older patients in the emergency department

Cheng-Yu Chien; Chung-Hsien Chaou; Chung-Cheng Yeh; Kuang-Hung Hsu; Shi-Ying Gao; Chip-Jin Ng

doi:10.1186/s12873-022-00646-0

Using mobility status as a frailty indicator to improve the accuracy of a computerised five-level triage system among older patients in the emergency department

BMC Emerg Med. 2022 May 19;22(1):86. doi: 10.1186/s12873-022-00646-0.

Authors

Cheng-Yu Chien^{1

2

3

4}, Chung-Hsien Chaou^{1

5}, Chung-Cheng Yeh⁶, Kuang-Hung Hsu^{1

7

8

9}, Shi-Ying Gao¹⁰, Chip-Jin Ng¹¹

Affiliations

¹ Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, No. 5 Fushing St., Gueishan Dist, Taoyuan City, 333, Taiwan.
² Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, 302, Taiwan.
³ Graduate Institute of Management, Chang Gung University, Taoyuan, 333, Taiwan.
⁴ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 100, Taiwan.
⁵ Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.
⁶ Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung, 204, Taiwan.
⁷ Laboratory for Epidemiology, Department of Health Care Management, Healthy Aging Research Center, Chang Gung University, Taoyuan, 333, Taiwan.
⁸ Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, 333, Taiwan.
⁹ Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, 243, Taiwan.
¹⁰ Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.
¹¹ Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, No. 5 Fushing St., Gueishan Dist, Taoyuan City, 333, Taiwan. ngowl@ms3.hinet.net.

Abstract

Background: Owing to societal ageing, the number of older individuals visiting emergency departments (EDs) has increased in recent years. For this patient population, accurate triage systems are required. This retrospective cohort study assessed the accuracy of a computerised five-level triage system, the Taiwan Triage and Acuity System (TTAS), by determining its ability to predict in-hospital mortality in older adult patients and compare it with the corresponding rate in younger adult patients presenting to EDs. The association between frailty, which the current triage system does not consider, was also investigated.

Methods: The medical records of adult patients admitted to a single ED between 2016 and 2017 were reviewed. Data collected included information on demographics, triage level, frailty status, in-hospital mortality, and medical resource utilisation. The patients were divided into four age groups: two older adult groups (older: 65-84 years and very old: ≥85 years) and two younger adult groups (young: 18-39 and middle-aged: 40-64 years).

Results: Our study included 265,219 ED adult patients, of whom 64,104 and 16,009 were in the older and very old groups, respectively. The in-hospital mortality rate at each triage level increased with age. The ability of the TTAS to predict in-hospital mortality decreased with age (area under the receiver operating characteristic curve [AUROC]: young: 0.86; middle-aged, 0.84; and older and very old: 0.79). Frailty was associated with in-hospital mortality (odds ratio, 2.20; 95% confidence interval, 2.03-2.38). Adding mobility status as a frailty indicator to TTAS only slightly improved its ability to predict in-hospital mortality (AUROC: 0.74-0.77) in patients ≥65 years of age.

Conclusions: The ability of the current triage system to predict in-hospital mortality decreases with age. Although frailty as mobility was associated with in-hospital mortality, its addition to the TTAS only slightly improved the accuracy with which in-hospital mortality in older patients presenting to EDs was predicted.

Keywords: Emergency department; Frailty; Older patients; Triage acuity scale.

MeSH terms

Aged
Aged, 80 and over
Emergency Service, Hospital
Frailty* / diagnosis
Hospital Mortality
Humans
Middle Aged
Retrospective Studies
Triage*