Performance of the Emergency Severity Index and Patient Acuity Category Scale in geriatric triage

Singapore will become a 'super-aged' society by 2026, with an expected rise in geriatric emergency department (ED) attendances. Conventional triage tools such as the Patient Acuity Category Scale (PACS) and Emergency Severity Index (ESI) may not fully capture the complex presentations of older adults. This study compared the triage outcomes between geriatric and non-geriatric patients.

A retrospective observational study was conducted in adult patients presenting to a tertiary ED between 1 February 2021 and May 2021. Patients were stratified into geriatric (age ≥65 years) and non-geriatric groups. Primary outcomes were ED length of stay (EDLOS) and hospital admission rates. Multivariable analyses were performed to adjust for confounders.

Overall EDLOS was longer in geriatric than non-geriatric patients in both unadjusted (317.4 vs. 217.2 min, P < 0.05) and adjusted (300.2 vs. 224.1 min, P < 0.05) analyses. Admission rates were also higher in geriatric patients (75.1% vs. 33.2%, P < 0.001). Stratified analyses showed significantly longer EDLOS in older patients in PACS 2 (346.3 vs. 286.7 min, P < 0.001) and ESI 3 (353.4 vs. 281.2 min, P < 0.001). Admission rates were higher in PACS 1-3 and ESI 1-4, with the highest odds in ESI 1 (odds ratio [OR] 65.9) and PACS 1 (OR 28.3).

Despite being assigned to higher acuity, older adults had longer EDLOS and higher admission rates than younger adults within the same triage category. This highlights a mismatch between triage allocation and care needs, requiring enhanced geriatric-specific risk-stratification approaches.