Evidence map›Paper›PMID 35346062›Full record

ArticleBMC emergency medicine2022

Effect of age adjustment on two triage methods.

Kirsi Kemp, Janne Alakare, Minna Kätkä, Mitja Lääperi, Lasse Lehtonen, Maaret Castrén

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC emergency medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.5field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 6 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 1 country.

Kirsi KempDepartment of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki Meilahden Tornisairaala, Haartmaninkatu 4, P.O. Box 340, 00029 HUS, Helsinki, Finland. kirsi.kemp@hus.fi.
Janne AlakareDepartment of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki Meilahden Tornisairaala, Haartmaninkatu 4, P.O. Box 340, 00029 HUS, Helsinki, Finland.
Minna KätkäDepartment of Emergency Medicine, Tampere University Hospital, Ensitie 8, P.O. Box 2000, 33521, Tampere, Finland.
Mitja LääperiDepartment of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki Meilahden Tornisairaala, Haartmaninkatu 4, P.O. Box 340, 00029 HUS, Helsinki, Finland.
Lasse LehtonenDepartment of Public Health, University of Helsinki and Helsinki University Hospital, Tukholmankatu 2B, P.O.BOX 20, 00014, Helsinki, Finland.
Maaret CastrénDepartment of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki Meilahden Tornisairaala, Haartmaninkatu 4, P.O. Box 340, 00029 HUS, Helsinki, Finland.
University of Helsinki · FIEspoo Music Institute · FIHelsinki University Hospital · FITampere University · FI

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMost emergency departments rely on acuity assessment, triage, to recognize critically ill patients that need urgent treatment, and to allocate resources according to need. The accuracy of commonly used triage instruments such as the Emergency Severity Index (ESI) is lower for older adults compared to young patients. We aim to examine, whether adjusting the triage category by age leads to improvement in sensitivity without excessive increase in patient numbers in the higher triage categories. The primary outcome measure was 3-day mortality and secondary outcomes were 30-day mortality, hospital admission, and HDU/ICU admissions.

methodsWe gathered data of all adult patients who had an unscheduled visit to any of our three emergency departments within one month. The data was analysed for 3-day mortality, 30-day mortality, hospital admission, and high dependency unit or intensive care unit (HDU/ICU) admission. The analysis was run for both the standard ESI triage method and a local 3-level Helsinki University Hospital (HUH) method. A further analysis was run for both triage methods with age adjustment. Net reclassification improvement values were calculated to demonstrate the effect of age adjustment.

resultsThirteen thousand seven hundred fifty-nine patients met the study criteria, median age was 57. 3-day mortality AUCs for unadjusted HUH and ESI triage were 0.77 (0.65-0.88) and 0.72 (0.57-0.87); 30-day mortality AUCs were 0.64 (0.59-0.69) and 0.69 (0.64-0.73); hospital admission AUCs were 0.60 (0.68-0.71) and 0.66 (0.65-0.68) and HDU/ICU admission AUCs were 0.67 (0.64-0.70) and 0.82 (0.79-0.86), respectively. Age adjustment improved accuracy for 30-day mortality and hospital admission. With the threshold age of 80, AUCs for 30-day mortality were 0.73 (0.68-0.77) and 0.77 (0.73-0.81) and for hospital admission, 0.66 (0.65-0.67) and 0.72 (0.71-0.73) for the HUH and ESI triage. The effect was similar with all cut off ages.

conclusionMoving older adults into a more urgent triage category based on age, improved the triage instruments' performance slightly in predicting 30-day mortality and hospital admission without excessive increase in patient numbers in the higher triage categories. Age adjustment did not improve HDU/ICU admission or 3-day mortality prediction.

Indexed as

Emergency Service, HospitalTriageAgedHospitalizationHumansIntensive Care UnitsMiddle AgedRetrospective StudiesAcuity assessmentEmergency DepartmentEmergency Severity IndexOlder adultsTriage

Identifiers

PMID35346062
PMCPMC8961917
OpenAlexW4221003937

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.