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Triage Risk Screening Tool (TRST)
TRST: Score 1 point for every risk factor present. Used exclusively in the Emergency Department triage setting.
Assess 6 Risk Factors
1. Cognitive Impairment
Evidence of cognitive decline, acute confusion, or positive rapid screen (e.g., Six-Item Screener < 4).
2. Living Alone
Patient lives alone or has no reliable caregiver available at home.
3. Mobility Impairment
Recent difficulty walking, transferring, or recent falls.
4. High Healthcare Utilization
ED visit in the past 30 days, or hospitalization in the past 90 days.
5. Polypharmacy
Taking 5 or more different medications.
6. Professional Judgement
Triage nurse suspects patient is failing to cope at home, suffering self-neglect, or abuse.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Emergency Department (ED) triage for adults ≥ 65 years.
Identifying older adults at high risk for subsequent ED revisit, hospitalization, or nursing home placement within 30-120 days.
Triggering acute Comprehensive Geriatric Assessment (CGA) consults in the ED.
Preventing the Bounce-Back
Older adults often present to the ED with a minor complaint (e.g., minor fall, UTI) but bounce back weeks later with a catastrophic decline. The TRST identifies the underlying geriatric syndromes driving the vulnerability.
Section 2
Formula & Logic
Scoring
6 binary risk factors assessed.
Total score: 0–6.
Score ≥ 2 indicates "High Risk" for adverse outcomes.
The 6 Risk Factors
Cognitive Impairment
Evidence of cognitive decline or positive screen (e.g., Six-Item Screener < 4).
Living Alone
Patient lives alone or with no available caregiver.
Mobility Impairment
Recent difficulty walking/transferring or recent falls.
ED Use
Admitted to ED in the previous 30 days or hospitalized in the previous 90 days.
Polypharmacy
Taking 5 or more different medications.
Professional Judgement
ED nurse feels the patient is failing to cope at home.
Section 3
Pearls/Pitfalls
Nursing Intuition is Scored
The 6th item ("Professional Judgement") is unique among validated tools. It explicitly validates the "end-of-the-bedogram" clinical gestalt of experienced triage nurses who recognize when a patient is declining, even if other metrics are borderline.
Section 4
Next Steps
Management
Section 5
Evidence Appraisal
Primary Reference
A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department.
Meldon SW et al. • Acad Emerg Med.. 2003;10(3):224-32. Validation of the TRST showing strong predictive value for 30- and 120-day outcomes.
Section 6
Origins
ED Geriatrics Integration
Developed to bridge the gap between fast-paced emergency medicine and comprehensive geriatric assessment. It extracts the most predictive elements of a 2-hour geriatric assessment into a 2-minute triage checklist.
