Older patients in ED undertriaged

About a quarter of elderly patients that come through the emergency department are undertriaged, that is, assessed as less sick than they actually are, according to a new study published in the Annals of Emergency Medicine on Wednesday. The study suggests the elderly population may be particularly vulnerable, pointing out the problems with care across the continuum.

Researchers looked at more than 519 patients over the age of 65 and found that undertriage occurred in 117 cases, mostly because EDs neglected high-risk situations or failed to appropriately interpret vital signs, according to the study.

"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," lead study author Christian Nickel of University Hospital Basel in Basel, Switzerland, said in the study announcement.

With older patients making up 12 to 21 percent of all emergency visits, ED providers might miss important conditions because many older patients have multiple, complicated histories of communication problems, depression or an altered mental status, or a combination of social and medical problems that make triaging acute illness even more difficult.

For example, older patients often present with nonspecific symptoms such as generalized weakness, which does not necessarily imply a high-risk situation, making the triage process challenging.

Study authors suggested that hospitals use the otherwise missed opportunity to improve triage training programs that stress the importance of vital signs, using a valid emergency severity index.

For more information:
- read the AEM study (.pdf)
- read the press release

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