Mortality risk for different presenting complaints amongst older patients assessed with the Manchester triage system

Abstract

Examine characteristics of older patients presenting to the ED triaged with the presentational flowchart 'unwell adult' of the Manchester Triage System (MTS) and to assess the different mortality and admission rates among triage categories. Findings• Older patients assigned to the 'unwell' flowchart have the highest non-trauma mortality rate, independent of urgency category, and highest admission rates of all presenting complaints. • Suprisingly, mortality was also observed in the lowest triage categories. MessagePatients in the category 'unwell' have the highest non-trauma 30-day mortality and highest hospital admission rates when compared to other presenting complaints, indicating that the nonspecific disease presentation "unwell" is a serious medical condition.

Diagnoses and mortality among prehospital emergency patients calling 112 with unclear problems: a population-based cohort study from Denmark

“…The mean age of the patients with ‘unclear problem’ in this study was 61.5 years compared to 55.3 years previous demonstrated for all patients with contact to Emergency department [ 19 ]. The older age of patients with ‘unclear problem’ corresponds to what has previously been shown for patients presenting to the ED with non-specific complaints [ 5 , 20 , 21 ]. However, our study showed that patients with an ‘unclear problem’ at the emergency call and who ended up with a non-specific diagnosis had a lower mean age than those with ‘unclear problem’ and specific diagnoses.…”

Identification through the Manchester Triage System of the older population at risk of delirium: A case–control study

“…The percentage of the older population attended in the ED in the present study is consistent with the data published elsewhere (Aminzadeh & Dalziel, 2002; Ashman et al, 2020; Bermúdez Menéndez de la Granda et al, 2018). On conducting triage analysis, we recorded a classification of the reasons for urgency similar to that found in other studies in the older population—with a higher percentage of cases corresponding to yellow (urgent) and green (not very urgent) priority in studies in Spain (Bermúdez Menéndez de la Granda et al, 2018) and Switzerland (Hasemann et al, 2018) compared to other studies in The Netherlands (Blomaard et al, 2020; Lucke et al, 2021), Germany (Brutschin et al, 2021) or the United States (Han et al, 2009), which identify the majority of the population in attendance as corresponding to yellow (urgent) or orange (very urgent). This could be due to heterogeneity in the type and access to resources in the healthcare systems of the different countries.…”

“…The aim of our study was to analyse which flow charts and discriminators of the but at the same time, shortcomings have been detected in some cases (Zachariasse et al, 2017), such as errors in application by inexperienced nursing staff; when screening more than one patient every 15 min; or in the triage of certain specific populations such as young patients or older individuals with comorbidities (Ausserhofer et al, 2021). In the older population, the atypical presentation of diseases makes the correct identification of the flow charts difficult, and there have even been reports of greater mortality among those identified as being of lowest priority (Brutschin et al, 2021;Lucke et al, 2021). Therefore, nursing knowledge of the specific characteristics of the older population is essential for proper triage (Grossmann et al, 2014).…”

Triage tools: a cautious (and critical) view towards their use in old patients

“…It should quickly detect which patients present potentially lethal situations or those with a higher risk of morbidity when not treated immediately, thus reducing the possible negative impact of a delay in treatment [16]. Since the triage process itself implies that not all needs are met immediately, it is essential to ensure that triage methods meet their objectives and should, therefore, also be evaluated against specific populations, as Lucke et al do in the older adult group in the present issue [17].…”

“…The work included in this issue by Lucke et al [17] aims to examine the characteristics of older patients seen in the ED who are classified as "sick adult" with the Manchester Triage System (MTS), by reviewing the different mortality and admission rates at different urgency levels for this category. The authors conclude that older patients are most often assigned the "adult unwell" presentation flowchart when using the MTS, and that patients in this category have the highest nontraumatic mortality and hospital admission rates compared with other presenting complaints.…”