Abstract
INTRODUCTION: Elderly patients in emergency departments (EDs) are at increased risk due to nonspecific symptoms, multimorbidity, and elevated mortality. This study compared the predictive performance of the Manchester Triage System (MTS) and the Emergency Severity Index (ESI) for hospitalization and critical outcomes in geriatric patients and analyzed symptom patterns by age and clinical course. METHODS: This retrospective study included all patients aged ≥18 years admitted to a tertiary ED in northern Poland between January and June 2021. Each patient was concurrently assessed using both MTS and ESI. Data collected included triage level, age group (18-64, 65-79, ≥ 80), sex, mode of arrival, presenting symptoms, and outcomes including hospitalization and ten predefined critical events (e.g., sepsis, admission, urgent surgery). Logistic regression was used to assess associations. RESULTS: Among 1,063 patients, 475 (44.7%) were aged ≥65. Patients aged 18-64 most commonly presented with abdominal pain or polytrauma, while geriatric patients more frequently reported dyspnea, weakness, and altered mental status. Dyspnea was nearly twice as common in patients ≥80. Weakness (OR = 1.67) and abdominal pain (OR = 1.64) were significantly associated with hospitalization. Hospitalization and critical events were more likely in older adults (OR = 2.03 for ages 65-79; OR = 3.74 for ≥80). In both systems, higher triage urgency was independently associated with greater risk (MTS: OR = 0.51; ESI: OR = 0.43). ESI showed stronger alignment with physiological deterioration and predicted complications such as ICU admission and sepsis more consistently than MTS. CONCLUSIONS: MTS and ESI show limited sensitivity in older patients, particularly with nonspecific presentations. ESI provided better discrimination of clinical urgency. Findings support revising triage systems to account for age, atypical symptoms, and geriatric vulnerability.