Revising Vital Signs Criteria for Accurate Triage of Older Adults in the Emergency Department

Objective: Because of physiologic changes in older adults, their vital signs need to be assessed differently. This study aimed to determine appropriate vital sign cut points for triage designation in older patients presented to the emergency department (ED). Patients and Methods: Data from 78,524 ED...

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Bibliographic Details
Published in:International journal of general medicine 2022-01, Vol.15, p.6227-6235
Main Authors: Su, Yi-Chia, Chien, Cheng-Yu, Chaou, Chung-Hsien, Hsu, Kuang-Hung, Gao, Shi-Ying, Ng, Chip-Jin
Format: Article
Language:English
Subjects:
Adults
Age
Aged patients
Decision-making
emergency department
Emergency service
Heart beat
Hospitals
Medical records
Mortality
older patients
Older people
Original Research
Patients
Physiology
Signs
Taiwan
Trauma
triage
United Kingdom
vital signs
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Summary:Objective: Because of physiologic changes in older adults, their vital signs need to be assessed differently. This study aimed to determine appropriate vital sign cut points for triage designation in older patients presented to the emergency department (ED). Patients and Methods: Data from 78,524 ED visits of patients aged [greater than or equal to]65 years in Linkou Chang Gung Memorial Hospital (LCGMH) between 2016 and 2017 were collected. New cut points for vital signs (systolic blood pressure [SBP], heart rate [HR], body temperature [BT], and Glasgow Coma Scale [GCS]) were determined using the critical event rate (the composite of admission to ICU and mortality in hospital) for each vital sign. The newly proposed triage scale was then validated using two other databases (Chang Gung Research Database [CGRD] and Taipei City Hospital [TPECH] database). The Taiwan Triage and Acuity Scale (TTAS) was used in this study. Results: In the LCGMH derivation group, older patients presenting with SBP < 80 mmHg, HR < 40 or > 140 beats per minute (bpm), BT < 35[degrees]C, and GCS score 3-8 had a critical event rate of >20% and were proposed to be uptriaged to TTAS level 1. Following a reclassification, a portion of older patients are uptriaged by the newly proposed TTAS, and increase in the critical event rate in TTAS level 1 and level 2 groups compared to the existing TTAS. The newly proposed TTAS exhibited comparable discriminatory ability for triage in older patients compared to the existing TTAS (the area under the receiver operating characteristics curve: CGRD, 0.76 vs 0.62; TPECH, 0.71 vs 0.59). Conclusion: Revising the vital signs triage criteria for older patients could be a way to improve the identification of patients with critical event outcomes in high TTAS level, thereby improving triage accuracy among older patients visiting the ED. Keywords: older patients, emergency department, triage, vital signs, decision-making
ISSN:1178-7074
1178-7074
DOI:10.2147/IJGM.S373396