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Mortality risk for different presenting complaints amongst older patients assessed with the Manchester triage system

Lucke, JA; Mooijaart, SP; Conroy, S; Blomaard, LC; De Groot, B; Nickel, CH; (2022) Mortality risk for different presenting complaints amongst older patients assessed with the Manchester triage system. European Geriatric Medicine , 13 pp. 323-328. 10.1007/s41999-021-00568-3. Green open access

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Abstract

Purpose: Older people often present to the Emergency Department with nonspecific complaints. We aimed (1) to examine characteristics of older patients presenting to the ED triaged with the presentational flowchart ‘unwell adult’ of the Manchester triage system (MTS) and (2) to assess the different mortality and admission rates among triage categories. Methods: Retrospective cohort study including all consecutive patients aged 70 years and older who visited the ED of a tertiary care hospital in the Netherlands during a 1-year period. The primary outcome was 30-day mortality. Secondary outcomes were 7-day mortality, hospital admission and ED length of stay. Results: 4255 patients were included in this study. Mean age was 78 years (IQR 73.9–83.4) and 2098 were male (49.3%). The MTS presentational flowchart ‘unwell adult’ was the most commonly used flowchart (n = 815, 19.3%). After the infrequent flowchart ‘major trauma’ (n = 9, 13.8%), ‘unwell adult’ had the highest 30-day mortality (n = 88, 10.8%). When compared to all other flowcharts, patients assigned as ‘unwell adult’ have significantly higher 30-day mortality rates (OR 1.89 (95%CI 1.46–2.46), p = < 0.001), also when adjusted for age, gender and triage priority (OR 1.75 (95%CI 1.32–2.31), p = < 0.001). Patients from the ‘unwell adult’ flowchart had the highest hospital admission rate (n = 540, 66.3%), and had among the longest ED length of stay. Conclusions: Older ED patients are most commonly assigned the presentational flowchart ‘unwell adult’ when using the MTS. Patients in this category have the highest non-trauma mortality and highest hospital admission rates when compared to other presenting complaints.

Type: Article
Title: Mortality risk for different presenting complaints amongst older patients assessed with the Manchester triage system
Location: Switzerland
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s41999-021-00568-3
Publisher version: https://doi.org/10.1007/s41999-021-00568-3
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Manchester triage system, Triage, Emergency department, Older patients, Mortality, Non-specific complaints
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10144647
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