Authors: Anwar Sultan F Alenezi , Jana Solaiman Alsobeihy , Bader Sulaiman Althunayyan , Abdullah Faez Aloufi , Azizah Fahad Alburaq , Hashim Abdulwahab Alsharif , Yousef Mesaed Al-Shammari , Abdulmajeed farahan A Alenazi ,

Abstract

Background: Unplanned emergency department (ED) readmissions within 30 day remain a major challenge in geriatric care, contributing to increased morbidity, mortality, and healthcare utilization. The triage risk screening tool (TRST) is frequently used to identify older adults at risk of adverse outcomes. However, its predictive accuracy at the conventional cutoff score of ≥2 remains uncertain, raising concerns about its standalone reliability. To systematically evaluate the diagnostic performance of the TRST (cutoff ≥2) in identifying elderly inpatients at risk of unplanned 30-day ED readmissions.
Methods: A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Searches were performed in PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. Eligible studies included cohort designs assessing the TRST in adults aged ≥65 years for predicting 30-day unplanned ED readmissions. Pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios were obtained using a random-effects bivariate model.
Results: Six studies with a total of 5,638 participants met the inclusion criteria. The pooled sensitivity was 0.705 [95% confidence intervals (CI): 0.612-0.783], and specificity was 0.443 (95% CI: 0.332-0.561), indicating moderate sensitivity but low specificity. The DOR was 1.902 (95% CI: 1.016-3.562), with likelihood ratios (positive likelihood ratio = 1.27, negative likelihood ratio = 0.67) suggesting limited discriminatory ability. Substantial heterogeneity was observed (I² = 78.9% for sensitivity; 97.5% for specificity), reflecting variability between studies.
Conclusion: The TRST at a cutoff score of ≥2 demonstrates moderate sensitivity but low specificity for predicting 30-day unplanned ED readmissions in older adults. While it may be useful as an initial screening tool, its clinical value is maximized when integrated into comprehensive geriatric assessments and structured transitional care programs to enhance prediction accuracy and reduce preventable readmissions.

Keywords: Triage risk screening tool, TRST, elderly, emergency department, readmission, diagnostic accuracy, systematic review, meta-analysis.