Predictive value of initial triage vital signs for critically ill older adults

Michael A Lamantia, Paul W Stewart, Timothy F Platts-Mills, Kevin J Biese, Cory Forbach, Ezequiel Zamora, Brenda K McCall, Frances S Shofer, Charles B Cairns, Jan Busby-Whitehead, John S Kizer, Michael A Lamantia, Paul W Stewart, Timothy F Platts-Mills, Kevin J Biese, Cory Forbach, Ezequiel Zamora, Brenda K McCall, Frances S Shofer, Charles B Cairns, Jan Busby-Whitehead, John S Kizer

Abstract

Introduction: Triage of patients is critical to patient safety, yet no clear information exists as to the utility of initial vital signs in identifying critically ill older emergency department (ED) patients. The objective of this study is to evaluate a set of initial vital sign thresholds as predictors of severe illness and injury among older adults presenting to the ED.

Methods: We reviewed all visits by patients aged 75 and older seen during 2007 at an academic ED serving a large community of older adults. Patients' charts were abstracted for demographic and clinical information including vital signs, via automated electronic methods. We used bivariate analysis to investigate the relationship between vital sign abnormalities and severe illness or injury, defined as intensive care unit (ICU) admission or ED death. In addition, we calculated likelihood ratios for normal and abnormal vital signs in predicting severe illness or injury.

Results: 4,873 visits by patients aged 75 and above were made to the ED during 2007, and of these 3,848 had a complete set of triage vital signs. For these elderly patients, the sensitivity and specificity of an abnormal vital sign taken at triage for predicting death or admission to an ICU were 73% (66,81) and 50% (48,52) respectively (positive likelihood ratio 1.47 (1.30,1.60); negative likelihood ratio 0.54 (0.30,0.60).

Conclusion: Emergency provider assessment and triage scores that rely primarily on initial vital signs are likely to miss a substantial portion of critically ill older adults.

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