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

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European Geriatric Medicine Aims and scope Submit manuscript

An Editorial to this article was published on 05 October 2021

Key summary points

AbstractSection Aim

Examine characteristics of older patients presenting to the ED triaged with the presentational flowchart ‘unwell adult’ of the Manchester triage system (MTS) and to assess the different mortality and admission rates among triage categories.

AbstractSection Findings

Older patients assigned to the ‘unwell’ flowchart have the highest non-trauma mortality rate, independent of urgency category, and highest admission rates of all presenting complaints. Surprisingly, mortality was also observed in the lowest triage categories.

AbstractSection Message

Patients in the category ‘unwell’ have the highest non-trauma 30-day mortality and highest hospital admission rates when compared to other presenting complaints, indicating that the nonspecific disease presentation "unwell" is a serious medical condition.

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.

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Availability of data

Data are available upon reasonable request through the corresponding author.

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Funding

No specific funding was obtained for this study, authors received grants for other work. Institute for Evidence-based Medicine in Old Age (ZonMw project number 627003001) and Acutely Presenting Older Patient study (ZonMw project number 627005001).

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Spaarne Gasthuis, Postbus 417, 2000 AK, Haarlem, The Netherlands

    J. A. Lucke

  2. Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands

    S. P. Mooijaart & L. C. Blomaard

  3. Institute for Evidence-Based Medicine in Old Age (IEMO), Leiden, The Netherlands

    S. P. Mooijaart

  4. Geriatric Medicine, MRC Unit for Lifelong Health and Ageing at UCL, London, UK

    S. Conroy

  5. Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands

    B. De Groot

  6. Emergency Department, University Hospital Basel, Basel, Switzerland

    C. H. Nickel

Authors
  1. J. A. Lucke
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  3. S. Conroy
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  4. L. C. Blomaard
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  6. C. H. Nickel
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Corresponding author

Correspondence to J. A. Lucke.

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Conflict of interest

There are no conflicts of interest reported by the authors of this study.

Ethical approval

The Medical Ethics Committee of the Leiden University Medical Center waived the need for approval of this study.

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Informed consent is not applicable. Because the medical ethics committee waived the need for approval, they also waived the need for informed consent. Data were obtained from the electronic patient files.

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Lucke, J.A., Mooijaart, S.P., Conroy, S. et al. Mortality risk for different presenting complaints amongst older patients assessed with the Manchester triage system. Eur Geriatr Med 13, 323–328 (2022). https://doi.org/10.1007/s41999-021-00568-3

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  • DOI: https://doi.org/10.1007/s41999-021-00568-3

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