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The journal of nutrition, health & aging

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04.05.2020 | Triage

Ability of Emergency Department Physicians Using a Functional Autonomy-Assessing Version of the Triage Risk Screening Tool to Detect Frail Older Patients Who Require Mobile Geriatric Team Consultation

verfasst von: I. Piffer, C. Goetz, Yinka Zevering, E. Andre, Z. Bourouis, N. Blettner

Erschienen in: The journal of nutrition, health & aging | Ausgabe 6/2020

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Abstract

Objectives

Frailty in older people associates with poor outcomes. Screening by ED physicians would greatly facilitate detection of frail older patients but our previous attempt to introduce routine ED-physician screening with Short Emergency Geriatric Assessment (SEGA), a 13-item frailty tool that French geriatricians use to identify frail patients, failed due to its length and complexity. A national committee recently generated a new version of the fast and simple 5-item Triage Risk Screening Tool (TRST) in which a subjective item (‘nurse concern’) was replaced by an item assessing basic activities of daily living. The ability of ED physicians using this French-TRST to accurately detect frail patients who require comprehensive geriatric assessment was assessed.

Design

Prospective cross-sectional study on diagnostic accuracy relative to the gold standard, namely, geriatrician-administered SEGA.

Setting

Tertiary-care hospital, France.

Subjects and measurements

The participants were 498 ≥75-year-old patients who visited the ED in 2018–2019 and were administered French-TRSTs by first ED physicians and then geriatricians, followed by SEGA, all within 24 hours. Diagnostic accuracy variables were calculated. Geriatrician-TRST was used to identify TRST items that associated with ED physician misclassification of frail patients.

Results

Emergency-TRST was significantly less sensitive than Geriatrician-TRST (88% vs. 93%; p=0.04) and tended to have lower negative predictive value (66% vs. 77%; p=0.09). Emergency-TRSTs rated four French-TRST items less well than Geriatrician-TRSTs.

Conclusions

As a substitute for SEGA in the ED, the French-TRST performed quite well overall but the ED physicians detected frail patients less well than the geriatricians. Modifications of the French-TRST that may improve the diagnostic performance of ED physicians are discussed.

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Titel: Ability of Emergency Department Physicians Using a Functional Autonomy-Assessing Version of the Triage Risk Screening Tool to Detect Frail Older Patients Who Require Mobile Geriatric Team Consultation
verfasst von: I. Piffer
C. Goetz
Yinka Zevering
E. Andre
Z. Bourouis
N. Blettner
Publikationsdatum: 04.05.2020
Verlag: Springer Paris
Schlagwörter: Triage
Geriatric Assessment
Erschienen in: The journal of nutrition, health & aging / Ausgabe 6/2020
Print ISSN: 1279-7707
Elektronische ISSN: 1760-4788
DOI: https://doi.org/10.1007/s12603-020-1378-4

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Ability of Emergency Department Physicians Using a Functional Autonomy-Assessing Version of the Triage Risk Screening Tool to Detect Frail Older Patients Who Require Mobile Geriatric Team Consultation

Abstract

Objectives

Design

Setting

Subjects and measurements

Results

Conclusions

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Abstract

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