Taş Gamze Nur, Pekdemir Murat, Özturan İbrahim Ulaş, Doğan Nurettin Özgür, Yaka Elif, Yılmaz Serkan
Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, İzmit, Kocaeli, Turkiye.
Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, İzmit, Kocaeli, Turkiye.
J Emerg Med. 2025 Jun;73:1-11. doi: 10.1016/j.jemermed.2024.12.005. Epub 2024 Dec 31.
Frailty is associated with adverse health outcomes in elderly patients presenting to the emergency department (ED). Assessing frailty in the elderly presenting to the ED, alongside triage, can predict adverse health outcomes.
The aim of this study was to investigate the prognostic performance of frailty assessment added to triage evaluation in patients with low acuity triage level.
This was a single-center, prospective cohort study conducted between November 2022 and August 2023. Patients ≥65 years old admitted to ED with urgent and nonurgent triage levels were included. The patients were categorized by triage level and frailty status classified by the Clinical Frailty Scale. The prognostic performance of triage, frailty, and the combined use of triage and frailty in predicting 30-day mortality, hospitalization, ED revisit, intensive care unit (ICU) admission, and ED disposition were determined.
The study included 1143 patients, of whom 837 (73.2%) were in the urgent triage category. There were 618 (54.1%) in the frail patient group. In predicting 30-day mortality, triage had a relative risk (RR) of 2.22 (95% CI: 1.19-4.15), sensitivity 86% (95% CI: 76-93), specificity 28% (95% CI: 35-30), frailty had an RR of 3.88 (95% CI: 2.20-6.84), sensitivity 82% (95% CI: 71-89), specificity, 48% (95% CI: 45-51), and combined triage and frailty these values were RR 7.08 (95%CI: 2.24-22.37), sensitivity 95% (95% CI: 86-99), specificity 30% (95% CI: 26-33).
Adding assessment of frailty to triage may enhance the prognostic performance in predicting 30-day mortality among older adults presenting to the ED with lower acuity triage level.
衰弱与到急诊科（ED）就诊的老年患者的不良健康结局相关。在对到急诊科就诊的老年人进行分诊的同时评估衰弱情况，可以预测不良健康结局。
本研究的目的是调查在低急症分诊级别的患者中，在分诊评估基础上增加衰弱评估的预后性能。
这是一项于2022年11月至2023年8月进行的单中心前瞻性队列研究。纳入年龄≥65岁、以紧急和非紧急分诊级别入住急诊科的患者。患者按分诊级别分类，并根据临床衰弱量表对衰弱状态进行分类。确定分诊、衰弱以及分诊与衰弱联合使用在预测30天死亡率、住院、急诊科复诊、重症监护病房（ICU）入住和急诊科处置方面的预后性能。
该研究纳入了1143名患者，其中837名（73.2%）属于紧急分诊类别。衰弱患者组有618名（54.1%）。在预测30天死亡率方面，分诊的相对风险（RR）为2.22（95%置信区间：1.19 - 4.15），敏感性为86%（95%置信区间：76 - 93），特异性为28%（95%置信区间：35 - 30）；衰弱的RR为3.88（95%置信区间：2.20 - 6.84），敏感性为82%（95%置信区间：71 - 89），特异性为48%（95%置信区间：45 - 51）；分诊与衰弱联合使用时，这些值分别为RR 7.08（95%置信区间：2.24 - 22.37），敏感性为95%（95%置信区间：86 - 99），特异性为30%（95%置信区间：26 - 33）。
在分诊基础上增加衰弱评估可能会提高对分诊级别较低的到急诊科就诊的老年人预测30天死亡率的预后性能。
