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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

  • Published:
The journal of nutrition, health & aging

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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Funding

Funding: This research did not receive any specific grants from funding agencies in the public, commercial, and not-for-profit sectors.

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Authors and Affiliations

  1. Department of Geriatrics, Mercy Hospital (CHR Metz-Thionville), Metz, France

    I. Piffer & N. Blettner

  2. Clinical Research Support Unit, Mercy Hospital (CHR Metz-Thionville), Metz, France

    C. Goetz

  3. SciMeditor Medical Writing and Editing Services, 142 rue d’Alsace Moulins-les-Metz, 57160, Metz, France

    Yinka Zevering

  4. Emergency Department, Mercy Hospital (CHR Metz-Thionville), Metz, France

    E. Andre & Z. Bourouis

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  1. I. Piffer
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  2. C. Goetz
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Corresponding author

Correspondence to Yinka Zevering.

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Conflicts of Interest: The authors have no conflicts.

Ethical Standards: The study protocol was approved by Ethics Committee Centre-Ouest I (Approval No. 2018T3-05) and was registered on the ClinicalTrials.gov registry (NCT03544957) and with the ANSM (IDRCB 2018-A01076-49).

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Piffer, I., Goetz, C., Zevering, Y. et al. 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. J Nutr Health Aging 24, 634–641 (2020). https://doi.org/10.1007/s12603-020-1378-4

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  • DOI: https://doi.org/10.1007/s12603-020-1378-4

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