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Elderly Are Under-Triaged in Emergency Departments

Normal vital signs may camouflage serious conditions that require immediate attention

MONDAY, Dec. 24 (HealthDay News) -- Older patients who present at emergency departments with "normal" vital signs may in fact be in need of immediate attention, according to an article published in the December issue of the Journal of Emergency Nursing.

Lisa Wolf, M.S., R.N., of the University of Massachusetts in Amherst, and colleagues cited a Swiss study of 11,000 patients presenting to emergency departments, including 9.3 percent who were aged 65 or older and designated as "home care impossible," a term similar to "social admit" in the United States. Although all of these patients were triaged into the lowest two categories, it turned out that 51 percent of them had serious medical conditions such as myocardial infarction, sepsis, dissecting abdominal aortic aneurysm, glycemic emergencies and stroke.

The researchers observed three main reasons for this high rate of under-triage: lack of recognition of neurologic symptoms, atypical presentation, and inadequate evaluation of vital signs.

"Older clients require a thorough and careful assessment for optimal triage; 'normal' vital signs are not necessarily normal in this population, and the physiologic changes that come with aging put these patients at higher risk," the authors conclude. "Vague presentations can mean delayed workups; accurate triage assessment is vital to deliver optimal care to these patients."

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