Revising Vital Signs Criteria for Accurate Triage of Older Adults in the Emergency Department

Abstract

Yi-Chia Su,1,2 Cheng-Yu Chien,1– 5 Chung-Hsien Chaou,1,2 Kuang-Hung Hsu,1,2,6,7 Shi-Ying Gao,1 Chip-Jin Ng1,2 1Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 2College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan; 4Graduate Institute of Management, Chang Gung University, Taoyuan, Taiwan; 5Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; 6Laboratory for Epidemiology, Chang Gung University, Taoyuan, Taiwan; 7Department of Urology, Chang Gung Memorial Hospital, Taoyuan, TaiwanCorrespondence: Chip-Jin Ng, Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, No. 5 Fushing St., Gueishan Dist., Taoyuan, 333, Taiwan, Tel [phone] # 2505, Fax [phone], Email [email protected]: Because of physiologic changes in older adults, their vital signs need to be assessed differently. This study aimed to determine appropriate vital sign cut points for triage designation in older patients presented to the emergency department (ED).Patients and Methods: Data from 78,524 ED visits of patients aged ≥ 65 years in Linkou Chang Gung Memorial Hospital (LCGMH) between 2016 and 2017 were collected. New cut points for vital signs (systolic blood pressure [SBP], heart rate [HR], body temperature [BT], and Glasgow Coma Scale [GCS]) were determined using the critical event rate (the composite of admission to ICU and mortality in hospital) for each vital sign. The newly proposed triage scale was then validated using two other databases (Chang Gung Research Database [CGRD] and Taipei City Hospital [TPECH] database). The Taiwan Triage and Acuity Scale (TTAS) was used in this study.Results: In the LCGMH derivation group, older patients presenting with SBP 140 beats per minute (bpm), BT 20% and were proposed to be uptriaged to TTAS level 1. Following a reclassification, a portion of older patients are uptriaged by the newly proposed TTAS, and increase in the critical event rate in TTAS level 1 and level 2 groups compared to the existing TTAS. The newly proposed TTAS exhibited comparable discriminatory ability for triage in older patients compared to the existing TTAS (the area under the receiver operating characteristics curve: CGRD, 0.76 vs 0.62; TPECH, 0.71 vs 0.59).Conclusion: Revising the vital signs triage criteria for older patients could be a way to improve the identification of patients with critical event outcomes in high TTAS level, thereby improving triage accuracy among older patients visiting the ED.Keywords: older patients, emergency department, triage, vital signs, decision-making

Keywords

• older patients
• emergency department
• triage
• vital signs
• decision-making