Background and importance 

Emergency Severity Index is a five-level triage tool in the emergency department that predicts the need for emergency department resources and the degree of emergency. However, it is unknown whether this is valid in patients aged greater than or equal to 65 years.

Objective 

The aim of the study was to compare the accuracy of the Emergency Severity Index triage system between emergency department patients aged 18–64 and greater than or equal to 65 years.

Design, settings, and participants 

This was a retrospective observational cohort study of adults who presented to a Finnish emergency department between 1 February 2018 and 28 February 2018. All data were collected from electronic health records.

Outcome measures and analysis 

The primary outcome was 3-day mortality. The secondary outcomes were 30-day mortality, hospital admission, high dependency unit or ICU admission, and emergency department length of stay. The area under the receiver operating characteristic curve and cutoff performances were used to investigate significant associations between triage categories and outcomes. The results of the two age groups were compared.

Main results 

There were 3141 emergency department patients aged 18–64 years and 2370 patients aged greater than or equal to 65 years. The 3-day mortality area under the curve in patients aged greater than or equal to 65 years was greater than that in patients aged 18–64 years. The Emergency Severity Index was associated with high dependency unit/ICU admissions in both groups, with moderate sensitivity [18–64 years: 61.8% (50.9–71.9%); greater than or equal to 65 years: 73.3% (63.5–81.6%)] and high specificity [18–64 years: 93.0% (92.0–93.8%); greater than or equal to 65 years: 90.9% (90.0–92.1%)]. The sensitivity was high and specificity was low for 30-day mortality and hospital admission in both age groups. The emergency department length of stay was the longest in Emergency Severity Index category 3 for both age groups. There was no significant difference in accuracy between age groups for any outcome.

Conclusion 

Emergency Severity Index performed well in predicting high dependency unit/ICU admission rates for both 18–64 years and greater than or equal to 65-year-old patients. It predicted the 3-day mortality for patients aged greater than or equal to 65 years with high accuracy. It was inaccurate in predicting 30-day mortality and hospital admission for both age groups.

中文翻译：

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老年人紧急严重程度指数的准确性

背景和重要性 

急诊严重程度指数是急诊科的五级分诊工具，用于预测急诊科资源需求和紧急程度。然而，尚不清楚这是否适用于年龄大于或等于 65 岁的患者。

客观的 

该研究的目的是比较18-64 岁和大于或等于 65 岁的急诊科患者的紧急严重程度指数分诊系统的准确性。

设计、设置和参与者 

这是一项对 2018 年 2 月 1 日至 2018 年 2 月 28 日期间到芬兰急诊科就诊的成年人进行的回顾性观察性队列研究。所有数据均来自电子健康记录。

结果测量和分析 

主要结果是 3 天死亡率。次要结局是 30 天死亡率、入院、高依赖病房或 ICU 入院以及急诊科住院时间。接受者操作特征曲线下面积和截止性能用于研究分类类别和结果之间的显着关联。比较了两个年龄组的结果。

主要结果 

急诊科患者 3141 人，年龄 18-64 岁，2370 人年龄≥65 岁。大于或等于 65 岁患者的 3 天死亡率曲线下面积大于 18-64 岁患者。紧急严重程度指数与两组中高依赖病房/ICU 入院率相关，敏感性中等 [18-64 岁：61.8% (50.9-71.9%)；大于或等于 65 岁：73.3% (63.5–81.6%)] 和高特异性 [18–64 岁：93.0% (92.0–93.8%)；大于或等于 65 岁：90.9% (90.0–92.1%)]。两个年龄组的 30 天死亡率和住院率的敏感性很高，特异性很低。急诊科住院时间在两个年龄组的紧急严重程度指数类别 3 中最长。

结论 

紧急严重程度指数在预测 18-64 岁和大于或等于 65 岁患者的高依赖病房/ICU 入院率方面表现良好。它以高精度预测年龄大于或等于 65 岁的患者的 3 天死亡率。对两个年龄组的 30 天死亡率和住院率的预测是不准确的。