Should age be incorporated into the adult triage algorithm in the emergency department?

Alexander D. Ginsburg, Lucas Oliveira J. e Silva, Aidan Mullan, Kubwimana Moses Mhayamaguru, Susan Bower, Molly M. Jeffery, Fernanda Bellolio

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To compare resource utilization and mortality between older and younger adult patients with similar ED chief complaints and ESI triage levels. Methods: This was an observational study of consecutive adult patients (age ≥ 40) who presented to an academic ED over a 1-year period with chest pain, abdominal pain, altered mental status, generalized weakness, or headache. Patients were categorized into 40–64, 65–79, and ≥ 80-year old groups. Mortality and utilization outcomes were compared between age groups through logistic regression models or Cox proportional hazards adjusting for ESI level and chief complaint. Odds ratios (OR) and hazard ratios (HR) were calculated with 95% confidence intervals (CI). Results: A total of 9798 ED visits were included. As compared to younger adults (age 40–64), older adults, independently of ESI level and chief complaint, had higher ED laboratory use (OR 1.46 [CI 1.29, 1.66] for age 65–80; OR 1.33 [CI 1.15, 1.55] for age ≥ 80), ED radiology use (OR 1.40 [CI 1.26, 1.56]; OR 1.48 [CI 1.30, 1.69]), hospital admission (OR 1.56 [CI 1.42, 1.72]; OR 1.97 [CI 1.75, 2.21]), and ICU admission (OR 1.38 [CI 1.15, 1.65]; OR 1.23 [CI 0.99, 1.52]). Despite similar ESI and chief complaint, patients age 65–79 and ≥ 80 had higher 30-day mortality rates (HR 1.87 [CI 1.39 to 2.51] and 2.47 [CI 1.81 to 3.37], respectively). Conclusions: Older adults with similar chief complaints and ESI levels than younger adults, have significantly higher ED resource use, hospitalization rates, and mortality.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - 2020

ASJC Scopus subject areas

  • Emergency Medicine

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