Evaluating sarcopenia in emergency department triage: implications for hospitalization and critical care

Background: Sarcopenia, characterized by age-related declines in skeletal muscle mass, strength, and physical performance, is common in older adults yet remains under-recognized in emergency medical settings. Despite its strong association with frailty and adverse clinical outcomes, sarcopenia is not routinely assessed in emergency department (ED) triage. This study aimed to determine the prevalence of possible sarcopenia among elderly adults presenting to the ED and evaluate its association with hospital admission and length of stay (LOS). Methods: A prospective cohort study was conducted in a tertiary urban ED in Taiwan between December 2020 and April 2021. Patients aged ≥65 years were consecutively enrolled and assessed for possible sarcopenia. Frailty was evaluated using the Edmonton Frail Scale and the Eastern Cooperative Oncology Group performance status. The primary outcomes included ED disposition (hospital admission versus discharge) and unfavorable discharge outcomes. Secondary outcomes comprised hospital LOS and National Health Insurance (NHI) reimbursement points. Linear regression and multivariable logistic analyses were conducted, along with receiver operating characteristic (ROC) analysis. Results: Of the 890 patients enrolled, 481 (54.0%) were sarcopenic and were significantly older, had lower body weight, and exhibited higher frailty scores (p < 0.001). Sarcopenia was associated with higher rates of hospital admission (p < 0.001) and prolonged LOS (p < 0.001). After adjustment, sarcopenia independently predicted hospital admission (adjusted odds ratio (aOR) 1.39; 95% Confidence Interval (CI), 1.04–1.87) and extended LOS (aOR 3.29; 95% CI, 1.78–4.80). ROC analysis demonstrated moderate predictive capability (Area Under the Curve (AUC) = 0.706). Additionally, NHI reimbursement points and unfavorable discharge outcomes were significantly associated with sarcopenia. Conclusions: Sarcopenia is both prevalent and independently associated with adverse clinical outcomes among elderly adults in the ED. Incorporating sarcopenia assessment into triage protocols may improve early risk stratification and support more informed clinical decision-making in this population. Clinical Trial Registration: NCT04862936.

Sarcopenia; Emergency department; Frailty; Hospital admission; Intensive care unit

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