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Weakness is a common presenting symptom in patients in the emergency de-
partment (ED), and is an obvious challenge to ED physicians [28]. A number of all
non-trauma patients (19.7% ) admitted to the ED complained of some form of weak-
ness easily recognized by ED nurses and ED physicians. Localized weakness is well
described and may be called a “stroke-like symptom” [34]. Generalized weakness
is most often caused by serious disease requiring immediate attention [28].
Frail elderly patients admitted without specific complaints are at risk of inap-
propriate or delayed evaluation due to undertriage at the door of the ED. A more
specific geriatric assessment should be integrated early in the triage process of these
patients. Emergency department admission decisions for elderly adults rely on var-
ious medical and social factors, along with the availability of timely follow-up [31].
These may include:
Patient data and test results (e.g., Age, ESI level, Heart rate, Diastolic blood
pressure, lab results)
Patient Chief complaints (e.g. General weakness, Fainting (syncope), Chest
pain, Neurologic weakness, Shortness of breath, Labored or difficult breathing,
Vomiting, Abdominal pain, Decreased appetite, Blood in stool, Blood in urine,
Painful urination, Patient History (e.g.Nonischemic heart disease, Cerebrovas-
cular disease (stroke), Pneumonia, Anemia, Diabetes)
Cognitive/Psychiatric state
Injury (e.g. Leg / hip fracture / dislocation, Head / neck / facial injury)
Index scores (e.g. Charlson Comorbidity Index Score)
Other factors such as: patient lives alone, suspected elderly abuse/neglect, re-
cently discharged, polypharmacy, adverse drug affects, alcohol abuse.
These general components contribute with varying degrees to the decision an emer-
gency care physician makes to admit or discharge the elderly patient after a visit to
the ED.
27.3.4
Decision Support Systems for ED Triage
The significance of the ED triage assessment has lead researchers to investigate and
developed Decision Support Systems for ED Triage. A Web-based triage decision
support tool (eTRIAGE) based on the Canadian Triage and Acuity Scale (CTAS)
has been developed in Canada and is now used in a number of ED regional hospi-
tals. Decision support, such as an electronic triage tool, can assist the medical staff
performing triage by displaying the key elements for each complaint, so that to help
define the criteria for each triage level. It is expected that experienced triage staff
are better able to estimate a triage level based on their initial clinical assessment
than those with less experience, giving them greater confidence to override the tool
if required [56].
Wilkes and colleagues [52] proposed a system of cognitive agents and a super-
visor, dubbed the TriageBot System that would gather both logistical and medical
information, as well as take diagnostic measurements, from an incoming patient for
 
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