Using mobility status as a frailty indicator to improve the accuracy of a computerised five-level triage system among older patients in the emergency department

Chien, Cheng-Yu; Chaou, Chung-Hsien; Yeh, Chung-Cheng; Hsu, Kuang-Hung; Gao, Shi-Ying; Ng, Chip-Jin

doi:10.1186/s12873-022-00646-0

Cited by 8 publications

(7 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…How to identify critically ill patients at an early stage under high load and improve the accuracy of triage and evaluation is particularly important. At present, the emergency prediction of critically ill patients mostly adopts vital sign assessment method, NEWS, emergency pre-examination and triage expert consensus, adult velevel emergency triage system and so on [11][12] . In each scoring table, those with fewer indicators are convenient to use, but their accuracy may be poor, while those with more indicators improve their accuracy, but the indicators are not easy to obtain, which prolongs the triage time.…”

Section: Discussionmentioning

confidence: 99%

Discussion on the prediction model of early judgment of critical risk in emergency patients

Li,

Lv,

et al. 2024

Preprint

View full text Add to dashboard Cite

Objective: To establish a predictive model for early assessment of critical risk in emergency patients and evaluate its clinical clinical benefits. Method: Clinical data of 3859 patients who visited the emergency department at Hebei General Hospital from November 2021 to December 2021 were selected. The enrolled patients were randomly divided into a training set (2703 cases) and a validation set (1156 cases) in a 7:3 ratio. In the training set, a predictive model was established based on the results of multivariate logistic stepwise regression analysis. At the same time, risk levels were divided, and the predictive efficacy and clinical benefits of the predictive model were verified. Result: There was no statistically significant difference in clinical data between the training and validation set (P>0.05), indicating comparability between the two groups. Multivariate logistic stepwise regression analysis showed that Gender, age, HR, R, SBP, SPO2, consciousness, pupil, mental state, and pain score were independent risk factors for early assessment of critical risk (P<0.05), and a predictive model was established based on this. Using conditional inference tree, critical risks are classified into low risk (P≤0.075), medium risk (0.075＜P≤0.656), and high risk (P>0.656). Furthermore, the prediction model was internally validated in both the training and validation sets, with a training set AUC of 0.926 [95% CI (0.912-0.939), P<0.001] and a validation set AUC of 0.911 [95% CI (0.886-0.936), P<0.001], indicating good discrimination of the prediction model; The calibration curve of the training set fits the standard curve, while the calibration curve of the validation set model slightly deviates from the standard curve. In the Hosmer Limeshow test, the results of the two groups were P=0.180 and P=0.546, respectively, indicating good calibration of the predicted model; The DCA curve suggests that both groups of people can achieve good clinical benefits. Conclusion: Establishing a predictive model for early assessment of emergency critical risk is helpful for early identification and intervention of emergency critical patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Discussion on the prediction model of early judgment of critical risk in emergency patients

Li,

Lv,

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…The TTAS was adapted from the CTAS and has been widely used in every EDs in Taiwan [ 18 ]. Despite the overall validity and reliability of the TTAS, it lacks a modifier for older patients [ 29 , 30 ]. Ng et al have reported that the incorporation of the CFS into TTAS has the potential to reduce the under-triage of older adults in the ED [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

A novel scale for triage assessment of frailty in the emergency department (ED-FraS): a prospective videotaped study

Liew,

Chen,

Sung

et al. 2024

BMC Geriatr

View full text Add to dashboard Cite

Background Rapid recognition of frailty in older patients in the ED is an important first step toward better geriatric care in the ED. We aimed to develop and validate a novel frailty assessment scale at ED triage, the Emergency Department Frailty Scale (ED-FraS). Methods We conducted a prospective cohort study enrolling adult patients aged 65 years or older who visited the ED at an academic medical center. The entire triage process was recorded, and triage data were collected, including the Taiwan Triage and Acuity Scale (TTAS). Five physician raters provided ED-FraS levels after reviewing videos. A modified TTAS (mTTAS) incorporating ED-FraS was also created. The primary outcome was hospital admission following the ED visit, and secondary outcomes included the ED length of stay (EDLOS) and total ED visit charges. Results A total of 256 patients were included. Twenty-seven percent of the patients were frail according to the ED-FraS. The majority of ED-FraS was level 2 (57%), while the majority of TTAS was level 3 (81%). There was a weak agreement between the ED-FraS and TTAS (kappa coefficient of 0.02). The hospital admission rate and charge were highest at ED-FraS level 5 (severely frail), whereas the EDLOS was longest at level 4 (moderately frail). The area under the Receiver Operating Characteristic curve (AUROC) in predicting hospital admission for the TTAS, ED-FraS, and mTTAS were 0.57, 0.62, and 0.63, respectively. The ED-FraS explained more variation in EDLOS (R2 = 0.096) compared with the other two methods. Conclusions The ED-Fras tool is a simple and valid screening tool for identifying frail older adults in the ED. It also can complement and enhance ED triage systems. Further research is needed to test its real-time use at ED triage internationally.

show abstract

“…It is the common opinion of the authors that 5LTs, due to their increased accuracy and safety, are better than 3LT or 4LT systems. The fact that this advantage also affects geriatric patients has not yet been widely studied [3,8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study

Savioli,

Ceresa,

Bressan

et al. 2024

JPM

View full text Add to dashboard Cite

Elderly patients, when they present to the emergency department (ED) or are admitted to the hospital, are at higher risk of adverse outcomes such as higher mortality and longer hospital stays. This is mainly due to their age and their increased fragility. In order to minimize this already increased risk, adequate triage is of foremost importance for fragile geriatric (>75 years old) patients who present to the ED. The admissions of elderly patients from 1 January 2014 to 31 December 2020 were examined, taking into consideration the presence of two different triage systems, a 4-level (4LT) and a 5-level (5LT) triage system. This study analyzes the difference in wait times and under- (UT) and over-triage (OT) in geriatric and general populations with two different triage models. Another outcome of this study was the analysis of the impact of crowding and its variables on the triage system during the COVID-19 pandemic. A total of 423,257 ED presentations were included. An increase in admissions of geriatric, more fragile, and seriously ill individuals was observed, and a progressive increase in crowding was simultaneously detected. Geriatric patients, when presenting to the emergency department, are subject to the problems of UT and OT in both a 4LT system and a 5LT system. Several indicators and variables of crowding increased, with a net increase in throughput and output factors, notably the length of stay (LOS), exit block, boarding, and processing times. This in turn led to an increase in wait times and an increase in UT in the geriatric population. It has indeed been shown that an increase in crowding results in an increased risk of UT, and this is especially true for 4LT compared to 5LT systems. When observing the pandemic period, an increase in admissions of older and more serious patients was observed. However, in the pandemic period, a general reduction in waiting times was observed, as well as an increase in crowding indices and intrahospital mortality. This study demonstrates how introducing a 5LT system enables better flow and patient care in an ED. Avoiding UT of geriatric patients, however, remains a challenge in EDs.

show abstract

Using mobility status as a frailty indicator to improve the accuracy of a computerised five-level triage system among older patients in the emergency department

Cited by 8 publications

References 23 publications

Discussion on the prediction model of early judgment of critical risk in emergency patients

Discussion on the prediction model of early judgment of critical risk in emergency patients

A novel scale for triage assessment of frailty in the emergency department (ED-FraS): a prospective videotaped study

Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study

Contact Info

Product

Resources

About