Elderly Are at Risk for Under-Triage in ERs

For Immediate Release     
March 8,2012                        

Contact:     Julie Lloyd
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Elderly Are at Risk for Under-Triage in ERs

WASHINGTON-Nearly one-quarter of elderly patients coming to the emergency department were assessed as less critically ill than they actually were, or under-triaged. Under-triage occurred most frequently in patients with non-specific complaints, according to a study published online yesterday in Annals of Emergency Medicine ("At Risk Of Undertriage? Testing the Performance and Accuracy of the Emergency Severity Index in Older ED Patients") http://bit.ly/AF3XxK.

"Elderly patients make up a significant portion of emergency patients but they may come to the ER with atypical symptoms, making it more difficult for them to be accurately assessed," said lead study authorChristian Nickel, MD, of University Hospital Basel in Basel, Switzerland.  "Neglect of high-risk situations and failure to interpret vital signs appropriately were the main reasons these patients were evaluated as less ill than they actually were.  The often complex combination of social and medical problems in older patients can complicate the triage process."

Researchers at a single Swiss hospital evaluated 519patient records for patients triaged using the Emergency Severity Index(ESI).  They found under-triage in 117cases.  (Overtriage occurred in 15cases.)  In 13 of the undertriagedpatients, life-saving interventions were ultimately performed, including airwayand breathing support and/or emergency medication.

A high proportion (25 percent) of under-triage occurred in patients with non-specific complaints, such as generalized weakness, which does not necessarily imply a high risk situation.  Study authors theorize that non-specific complaints may be trivialized at triage, possibly because of unconscious age bias.

"Triage training programs should stress the importanceof vital signs when applying the ESI to older patients," said Dr. Nickel.  "Emergency personnel should be aware of the risk of under-triage in this vulnerable patient group, particularly in view of our aging population."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.


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