Vulnerable patient groups in the Emergency Department: association with hospitalization, Intensive Care Unit admission, and mortality.

Abstract

While triage systems focus on clinical acuity, patients at risk due to underlying vulnerabilities may be overlooked. Identifying specific vulnerability markers at triage could enhance early risk stratification. This study investigates the association between predefined vulnerability markers and adverse outcomes in emergency department patients, independently of triage level and presenting complaint. Prospective study of an all-comer population presenting to the emergency department of a tertiary care hospital. The patients were attributed to one or more vulnerable groups at triage. Among the 4191 included patients, several vulnerability markers were associated with adverse outcomes after adjustment for age and sex. Patients with cognitive impairment had significantly higher odds of 30-day mortality [odds ratio (OR) 2.24; 95% confidence interval (CI), 1.08-4.32]. Intensive care unit admission was more likely in patients with immunosuppression (OR 4.13; 95% CI, 2.14-7.40), substance use disorder (OR 1.82; 95% CI, 1.03-3.02), and diabetes (OR 1.73; 95% CI, 1.07-2.71). Hospital admission was associated with cognitive impairment, immunosuppression, substance use disorder, diabetes, recent surgical intervention, and psychiatric comorbidities. In contrast, no significant associations with adverse outcomes were found for those with medical devices, acutely intoxicated patients, pregnancy, migrant status, or patients with recent trauma. Certain vulnerability markers identifiable at triage are associated with specific adverse outcomes. These findings highlight the potential of pragmatic, early vulnerability assessment to improve risk stratification in the emergency department.