Evaluating the Prognostic Value of Adding Frailty to Triage Assessment in Elderly Patients With Lower Acuity Presentations in the Emergency Department

Abstract

Background

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.

Objectives

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.

Methods

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.

Results

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).

Conclusion

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.