Emergency and Critical Care Center, Kurashiki Central Hospital, Japan.
Emergency and Critical Care Center, Kurashiki Central Hospital, Japan.
Am J Emerg Med. 2019 Dec;37(12):2159-2164. doi: 10.1016/j.ajem.2019.03.006. Epub 2019 Mar 8.
In developed nations, the age of patients in emergency departments (ED) continues to increase. Many emergency triage systems, such as the Canadian Triage and Acuity Scale (CTAS), triage patients as a homogenous group, regardless of age. However, older adults have multiple comorbidities and a higher risk of undertriage. The Japan Acuity and Triage Scale (JTAS) was developed based on the CTAS and has been validated for overall adults. We assessed the validity of the JTAS for use in elderly ED patients.
This was a secondary analysis of a cohort study that previously validated the JTAS in self-presenting adults of all ages in the ED of a Japanese tertiary-care hospital. We included non-transferred patients who were ≥65 years old and triaged between June 2013 and May 2014. Our primary outcome measures were overall admission and ED length of stay. Our secondary outcomes included admission to the intensive care units (ICUs) and in-hospital mortality. We examined the association between the triage level and patient outcomes with multivariable logistic regression analysis (overall and ICU admission and in-hospital mortality) and the Kruskal-Wallis rank-sum test (ED length of stay).
We included a total of 11,087 elderly patients in our study. Higher odds ratios for overall and ICU admission and in-hospital mortality corresponded to higher acuity levels. ED length of stay was significantly longer in patients with a higher JTAS level (p < 0.001). Twenty-nine percent of admissions who were triaged as lower acuity levels were related to non-acute diseases including malignancy-related events.
Our study suggests an association between the JTAS triage level and clinical outcomes in self-presenting elderly patients, thereby demonstrating the validity of the JTAS in these patients. However, admission due to chronic diseases including malignancy was common in patients who were rated as low acuity level.
在发达国家，急诊科（ED）患者的年龄持续增长。许多紧急分诊系统，如加拿大分诊和 acuity 量表（CTAS），将患者作为同质群体进行分诊，而不考虑年龄。然而，老年人有多种合并症，并且过度分诊的风险更高。日本 acuity 和分诊量表（JTAS）是在 CTAS 的基础上开发的，已被验证适用于所有成年人。我们评估了 JTAS 在老年 ED 患者中的有效性。
这是一项队列研究的二次分析，该研究先前在日本一家三级护理医院的 ED 中对所有年龄段的自我呈现成年人验证了 JTAS 的有效性。我们纳入了≥65 岁且在 2013 年 6 月至 2014 年 5 月期间分诊的非转院患者。我们的主要结局指标是总体入院率和 ED 住院时间。我们的次要结局包括入住重症监护病房（ICU）和院内死亡率。我们通过多变量逻辑回归分析（总体和 ICU 入院和院内死亡率）和 Kruskal-Wallis 秩和检验（ED 住院时间）来检查分诊级别与患者结局之间的关联。
我们的研究共纳入了 11087 名老年患者。总体和 ICU 入院率和院内死亡率的比值比越高，表明严重程度越高。JTAS 级别较高的患者 ED 住院时间明显较长（p<0.001）。29%的分诊为较低 acuity 级别的入院与非急性疾病有关，包括恶性肿瘤相关事件。
我们的研究表明，JTAS 分诊级别与自我呈现的老年患者的临床结局之间存在关联，从而证明了 JTAS 在这些患者中的有效性。然而，由于包括恶性肿瘤在内的慢性疾病而入院的情况在被评为低 acuity 级别的患者中很常见。
