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BMC Health Serv Res. 2018 Jun 15;18(1):456. doi: 10.1186/s12913-018-3257-9.

Differences in triage category, priority level and hospitalization rate between young-old and old-old patients visiting the emergency department.

Author information

1
FORS Swiss Centre of Expertise in Social Sciences, University of Lausanne, Géopolis, 1015, Lausanne, Switzerland. sarah.vilpert@unil.ch.
2
Public Health Department of the Canton of Vaud, Av. des Casernes 2, Lausanne, 1014, Switzerland.
3
Réseau Santé Nord Broye, Center for Community Geriatrics, Av. des Sciences 1, 1400, Yverdon-les-Bains, Switzerland.
4
Department of Economics, University of Lausanne, Internef, 1015, Lausanne, Switzerland.
5
Service of Emergency Medicine, University of Lausanne Medical Center (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
6
Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Medical Center (CHUV), Mont-Paisible 16, 1011, Lausanne, Switzerland.

Abstract

BACKGROUND:

Emergency Department (ED) are challenged by the increasing number of visits made by the heterogeneous population of elderly persons. This study aims to 1) compare chief complaints (triage categories) and level of priority; 2) to investigate their association with hospitalization after an ED visit; 3) to explore factors explaining the difference in hospitalization rates among community-dwelling older adults aged 65-84 vs 85+ years.

METHODS:

All ED visits of patients age 65 and over that occurred between 2005 and 2010 to the University of Lausanne Medical Center were analyzed. Associations of hospitalization with triage categories and level of priority using regressions were compared between the two age groups. Blinder-Oaxaca decomposition was performed to explore how much age-related differences in prevalence of priority level and triage categories contributed to predicted difference in hospitalization rates across the two age groups.

RESULTS:

Among 39'178 ED visits, 8'812 (22.5%) occurred in 85+ patients. This group had fewer high priority and more low priority conditions than the younger group. Older patients were more frequently triaged in "Trauma" (20.9 vs 15.0%) and "Home care impossible" (10.1% vs 4.2%) categories, and were more frequently hospitalized after their ED visit (69.1% vs 58.5%). Differences in prevalence of triage categories between the two age groups explained a quarter (26%) of the total age-related difference in hospitalization rates, whereas priority level did not play a role.

CONCLUSIONS:

Prevalence of priority level and in triage categories differed across the two age groups but only triage categories contributed moderately to explaining the age-related difference in hospitalization rates after the ED visit. Indeed, most of this difference remained unexplained, suggesting that age itself, besides other unmeasured factors, may play a role in explaining the higher hospitalization rate in patients aged 85+ years.

KEYWORDS:

Emergency department; Geriatrics Health services; Home care impossible; Hospitalization

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