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The journal of nutrition, health & aging

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01-06-2020 | 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

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

Published in: The journal of nutrition, health & aging | Issue 6/2020

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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Title: 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
Authors: I. Piffer
C. Goetz
Yinka Zevering
E. Andre
Z. Bourouis
N. Blettner
Publication date: 01-06-2020
Publisher: Springer Paris
Keywords: Triage
Geriatric Assessment
Published in: The journal of nutrition, health & aging / Issue 6/2020
Print ISSN: 1279-7707
Electronic ISSN: 1760-4788
DOI: https://doi.org/10.1007/s12603-020-1378-4

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Abstract

Objectives

Design

Setting

Subjects and measurements

Results

Conclusions

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