Abstract
BackgroundWe evaluated the validity of the Canadian Triage and Acuity Scale (CTAS) in elderly emergency department (ED) patients. In particular, we examined the sensitivity and specificity of the CTAS for identifying elderly patients who received an immediate life-saving intervention in the ED.MethodsWe reviewed the medical records of consecutive patients who were 65 years of age or older and presented to a single academic ED within a three-month period. The CTAS triage scores were compared to actual patient course, including disposition, discharge outcome and resource utilization. We calculated the sensitivity and specificity of the CTAS triage for identifying patients who received an immediate intervention.ResultsOf the 1903 consecutive patients who were ≥ 65 years of age, 113 (5.9%) had a CTAS level of 1, 174 (9.1%) had a CTAS level of 2, 1154 (60.6%) had a CTAS level of 3, 347 (18.2%) had a CTAS level of 4, and 115 (6.0%) had a CTAS level of 5. As a patient's triage score increased, the severity (such as mortality and intensive care unit admission) and resource utilization increased significantly. Ninety-four of the patients received a life-saving intervention within an hour following their arrival to the ED. The CTAS scores for these patients were 1, 2 and 3 for 46, 46 and 2 patients, respectively. The sensitivity and specificity of a CTAS score of ≤ 2 for identifying patients for receiving an immediate intervention were 97.9% and 89.2%, respectively.ConclusionsThe CTAS is a triage tool with high validity for elderly patients, and it is an especially useful tool for categorizing severity and for recognizing elderly patients who require immediate life-saving intervention.
Highlights
We evaluated the validity of the Canadian Triage and Acuity Scale (CTAS) in elderly emergency department (ED) patients
Patient characteristics and triage scores Among the 14,588 patients who visited the ED, 1972 patients were 65 years or older; after excluding 69 of these patients (21 patients passed away before arrival, 39 patients visited for non-treatment purpose, 9 patients discharged themselves), a total of 1903 patients were included in the study (Figure 1)
The characteristics of the 1903 patients are shown in Table 3. 36.4% of the subjects were admitted to the hospital ward after ED treatment, and 10.2% of these patients were admitted to the intensive care unit (ICU), which is significantly different than patients under the age of 65 (P < 0.001)
Summary
We evaluated the validity of the Canadian Triage and Acuity Scale (CTAS) in elderly emergency department (ED) patients. We examined the sensitivity and specificity of the CTAS for identifying elderly patients who received an immediate life-saving intervention in the ED. It is extremely important to predict the need for immediate life-saving treatment among elderly emergency patients, who have more diverse presentations than other age groups; to date, no study has evaluated the use of the CTAS, which provides more information regarding early treatment than the ESI (which is a triage tool that predicts ED resource allocation). We assessed the sensitivity and specificity of the CTAS as a triage tool that can make predictions for elderly emergency patients who need immediate lifesaving intervention
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