Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Seoul, 110, Deokan-ro, Gwangmyeong-si, Gyeonggi-do, Republic of Korea.
Ewha Womans University Mokdong Hospital, Department of Emergency Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea.
Exp Gerontol. 2023 May;175:112136. doi: 10.1016/j.exger.2023.112136. Epub 2023 Mar 9.
While many patients visit the emergency department (ED) for various reasons, medical resources are limited. Therefore, various triage scale systems have been used to predict patient urgency and severity. South Korea has developed and used the Korean Triage and Accuracy Scale (KTAS) based on the Canadian classification tool. As the elderly population increases, the number of elderly patients visiting the ED also increases. However, in KTAS, there is no consideration for the elderly, and the same classification system as adults. The aim of this study is to verify the ability of KTAS to predict severity levels in the elderly group, compared to the adult group.
This is a retrospective study for patients who visited the ED at two centers between February 1, 2018 and January 31, 2021. The initial KTAS level, changed level at ED discharge, general patient character, ED treatment results, in-hospital mortality, and lengths of hospital and ED stays were acquired. Area under the receiver operating characteristics (AUROC) was used to verify the severity prediction ability of the elderly group to KTAS, and logistic regression analysis was used for the prediction up-triage of KTAS.
The enrolled patients in the study were 87,220 in the adult group and 37,627 in the elderly group. The proportion of KTAS up-triage was higher in the elderly group (1.9 % vs. 1.2 %, p < 0.001). The AUROC for the overall admission rate was 0.686, 0.667 in the adult and elderly group, the AUROC for ICU admission was 0.842, 0.767, and the AUROC for in-hospital mortality prediction was 0.809, 0.711, indicating a decrease in the AUROC value in the elderly group. The independent factors of the up-triage predictors were old age, male gender, pulse, and ED length of stay, and old age was the most influential variable.
KTAS was poorly associated with severity in the elderly than in adults, and it was found that up-triaging was more likely to occur in the elderly. The severity and urgency of patients over 65 years of age should not be underestimated when initially determining the triage scale.
尽管许多患者因各种原因前往急诊部（ED），但医疗资源有限。因此，已经使用了各种分诊量表系统来预测患者的紧急程度和严重程度。韩国根据加拿大分类工具开发并使用了韩国分诊和准确性量表（KTAS）。随着老年人口的增加，前往 ED 的老年患者数量也在增加。然而，在 KTAS 中，没有考虑到老年人，并且使用的是与成年人相同的分类系统。本研究的目的是验证 KTAS 预测老年组严重程度的能力，与成年组相比。
这是一项回顾性研究，研究对象为 2018 年 2 月 1 日至 2021 年 1 月 31 日期间在两个中心就诊的 ED 患者。获得初始 KTAS 水平、ED 出院时的变化水平、一般患者特征、ED 治疗结果、住院死亡率以及住院和 ED 停留时间。接收者操作特征曲线（AUROC）下面积用于验证 KTAS 对老年组严重程度的预测能力，并进行逻辑回归分析以预测 KTAS 的上调。
研究共纳入 87220 例成年组和 37627 例老年组患者。老年组 KTAS 上调的比例较高（1.9%比 1.2%，p<0.001）。总体入院率的 AUROC 为 0.686，成年组和老年组分别为 0.667，ICU 入院率的 AUROC 为 0.842，成年组和老年组分别为 0.767，住院死亡率预测的 AUROC 为 0.809，成年组和老年组分别为 0.711，表明老年组的 AUROC 值下降。上调预测因素的独立因素是年龄较大、男性、脉搏和 ED 住院时间，年龄较大是最具影响力的变量。
与成年人相比，KTAS 与老年人的严重程度相关性较差，并且发现老年人更有可能上调。在最初确定分诊量表时，不应低估 65 岁以上患者的严重程度和紧迫性。
