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Examining the relationship between triage acuity and frailty to inform the care of older emergency department patients: Findings from a large Canadian multisite cohort study

  • Fabrice Mowbray (a1), Audrey-Anne Brousseau (a2), Eric Mercier (a3), Don Melady (a4), Marcel Émond (a3) and Andrew P. Costa (a1)...

Abstract

Background

The 2016 Canadian Triage and Acuity Scale (CTAS) updates introduced frailty screening within triage to more accurately code frail patients who may deteriorate waiting for care. The relationship between triage acuity and frailty is not well understood, but may help inform which supplemental geriatric assessments are beneficial to support care in the emergency department (ED). Our objectives were to investigate the relationship between triage acuity and frailty, and to compare their associations with a series of patient outcomes.

Methods

We conducted a secondary analysis of the Canadian cohort from a multinational prospective study. Data were collected on ED patients 75 years of age and older from eight ED sites across Canada between November 2009 and April 2012. Triage acuity was assigned using the CTAS, whereas frailty was measured using an ED frailty index. Spearman rank and binary logistic regression were used to examine associations.

Results

A total of 2,153 ED patients were analyzed. No association was found between the CTAS and ED frailty index scores assigned to patients (r = .001; p = 0.99). The ED frailty index was associated with hospital admission (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.4–1.6), hospital length of stay (OR = 1.4; 95% CI = 1.2–1.6), future hospitalization (OR = 1.1; 95% CI = 1.05–1.2), and ED recidivism (OR = 1.1; 95% CI = 1.04–1.2). The CTAS was associated with hospital admission (e.g., CTAS 2 v. 5; OR = 6; 95% CI = 3.3–11.4).

Conclusion

Our findings demonstrate that frailty and triage acuity are independent but complementary measures. EDs may benefit from comprehensive frailty screening post-triage, as frailty and its associated geriatric syndromes drive outcomes separate from traditional measures of acuity.

Contexte

L’Échelle canadienne de triage et de gravité (ECTG) a été mise à jour en 2016 et un nouvel élément de reconnaissance de la fragilité a été intégré au triage afin que les patients fragiles dont l’état est susceptible de se détériorer durant l'attente des soins reçoivent un score plus exact de gravité. On ne connaît pas très bien la relation entre l’évaluation du degré de gravité durant le triage et la fragilité, mais elle permettrait de préciser les évaluations supplémentaires en gériatrie utiles à la prestation de soins au service des urgences (SU). L’étude visait donc à examiner la relation entre l’évaluation du degré de gravité durant le triage et la fragilité, et à comparer les associations établies avec différents résultats cliniques.

Méthode

Il s'agit d'une analyse secondaire de la cohorte canadienne ayant participé à une étude prospective internationale. Des données ont été recueillies sur des patients âgés de 75 ans et plus, examinés dans l'un des 8 SU participants au Canada, entre novembre 2009 et avril 2012. Les scores de gravité ont été accordés selon l'ECTG durant le triage, et la fragilité a été mesurée selon un indice de fragilité appliqué au SU. Les associations ont été évaluées à l'aide de la corrélation de rangs de Spearman et d'une analyse de régression logistique binaire.

Résultats

Ont été analysés, au total, les dossiers de 2153 patients examinés au SU. Aucune association n'a été établie entre les cotes de gravité selon l'ECTG et les scores de l'indice de fragilité utilisé au SU (r = 0,001; p = 0,99). Toutefois, l'indice de fragilité accordé au SU était associé aux hospitalisations (risque relatif approché [RRA] = 1,5; IC à 95% = 1,4–1,6), à la durée du séjour à l'hôpital (RRA = 1,4; IC à 95% = 1,2–1,6), aux hospitalisations ultérieures (RRA = 1,1; IC à 95% = 1,05–1,2) et aux nouvelles consultations au SU (RRA = 1,1; IC à 95% = 1,04–1,2). Quant à l'ECTG, elle était associée aux hospitalisations (p. ex. score de 2 contre 5 sur l'ECTG : RRA = 6; IC à 95% = 3,3–11,4).

Conclusion

D'après les résultats de l’étude, la fragilité et l’évaluation du degré de gravité durant le triage sont des mesures indépendantes mais complémentaires. Aussi une recherche approfondie de la fragilité après le triage pourrait-elle se révéler utile dans les SU, puisque la fragilité et les syndromes gériatriques connexes produisent des résultats cliniques indépendants de ceux associés aux mesures habituelles du degré de gravité.

Copyright

Corresponding author

Correspondence to: Dr. Andrew P. Costa, Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, Ontario, Canada L8S 4K1; Email: acosta@mcmaster.ca

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Examining the relationship between triage acuity and frailty to inform the care of older emergency department patients: Findings from a large Canadian multisite cohort study

  • Fabrice Mowbray (a1), Audrey-Anne Brousseau (a2), Eric Mercier (a3), Don Melady (a4), Marcel Émond (a3) and Andrew P. Costa (a1)...

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