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.
Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, 302, Taiwan.
BMC Emerg Med. 2022 May 19;22(1):86. doi: 10.1186/s12873-022-00646-0.
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.
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).
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.
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.
由于社会老龄化，近年来前往急诊部（ED）的老年患者人数有所增加。对于这一患者群体，需要有准确的分诊系统。本回顾性队列研究评估了一种计算机化的五级分诊系统，即台湾分诊和急症系统（TTAS）的准确性，通过确定其预测老年患者住院死亡率的能力，并将其与年轻成年患者的相应比率进行比较。本研究还调查了目前的分诊系统未考虑到的脆弱性的相关性。
回顾了 2016 年至 2017 年间在一家 ED 收治的成年患者的病历。收集的数据包括人口统计学信息、分诊级别、脆弱状态、住院死亡率和医疗资源利用情况。患者被分为四个年龄组：两个老年组（65-84 岁和非常老：≥85 岁）和两个年轻成年组（18-39 岁和 40-64 岁）。
我们的研究包括 265219 名 ED 成年患者，其中 64104 名和 16009 名分别在老年组和非常老年组。每个分诊级别中的住院死亡率随年龄增长而增加。TTAS 预测住院死亡率的能力随年龄增长而降低（接受者操作特征曲线下面积[AUROC]：年轻：0.86；中年：0.84；老年和非常老：0.79）。脆弱性与住院死亡率相关（优势比，2.20；95%置信区间，2.03-2.38）。将移动状态作为脆弱性指标添加到 TTAS 中，仅略微提高了预测≥65 岁患者住院死亡率的能力（AUROC：0.74-0.77）。
目前的分诊系统预测住院死亡率的能力随年龄增长而降低。虽然脆弱性与移动性相关，但将其添加到 TTAS 中仅略微提高了预测 ED 老年患者住院死亡率的准确性。
