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Triage Tool (triage + tool)
Selected AbstractsPredictive Validity of a Computerized Emergency Triage ToolACADEMIC EMERGENCY MEDICINE, Issue 1 2007Sandy L. Dong MD Abstract Background Emergency department (ED) triage prioritizes patients on the basis of the urgency of need for care. eTRIAGE is a Web-based triage decision support tool that is based on the Canadian Triage and Acuity Scale (CTAS), a five level triage system (CTAS 1 = resuscitation, CTAS 5 = nonurgent). Objectives To examine the validity of eTRIAGE on the basis of resource utilization and cost as measures of acuity. Methods Scores on the CTAS, specialist consultations, computed-tomography use, ED length of stay, ED disposition, and estimated ED and hospital costs (if the patient was subsequently admitted to hospital) were collected for each patient over a six month period. These data were queried from a database that captures all regional ED visits. Correlations between CTAS score and each outcome were measured by using logistic regression models (categorical variables), univariate analysis of variance (continuous variables), and the Kruskal-Wallis analysis of variance (costs). A multivariate regression model that used cost as the outcome was used to identify interaction between the variables presented. Results Over the six month study, 29,524 patients were triaged by using eTRIAGE. When compared with CTAS level 3, the odds ratios for consultation, CT scan, and admission were significantly higher in CTAS 1 and 2 and were significantly lower in CTAS 4 and 5 (p < 0.001). When compared with CTAS levels 2,5 combined, the odds ratio for death in CTAS 1 was 664.18 (p < 0.001). The length of stay also demonstrated significant correlation with CTAS score (p < 0.001). Costs to the ED and hospital also correlated significantly with increasing acuity (median costs for CTAS levels in Canadian dollars: CTAS 1 =$2,690, CTAS 2 =$433, CTAS 3 =$288, CTAS 4 =$164, CTAS 5 =$139, and p < 0.001). Significant interactions between the data collected were found in a multivariate regression model, although CTAS score remained highly associated with costs. Conclusions Acuity measured by eTRIAGE demonstrates excellent predictive validity for resource utilization and ED and hospital costs. Future research should focus on specific presenting complaints and targeted resources to more accurately assess eTRIAGE validity. [source] Reliability of Computerized Emergency TriageACADEMIC EMERGENCY MEDICINE, Issue 3 2006Sandy L. Dong MD Objectives: Emergency department (ED) triage prioritizes patients based on urgency of care. This study compared agreement between two blinded, independent users of a Web-based triage tool (eTRIAGE) and examined the effects of ED crowding on triage reliability. Methods: Consecutive patients presenting to a large, urban, tertiary care ED were assessed by the duty triage nurse and an independent study nurse, both using eTRIAGE. Triage score distribution and agreement are reported. The study nurse collected data on ED activity, and agreement during different levels of ED crowding is reported. Two methods of interrater agreement were used: the linear-weighted , and quadratic-weighted ,. Results: A total of 575 patients were assessed over nine weeks, and complete data were available for 569 patients (99.0%). Agreement between the two nurses was moderate if using linear , (weighted ,= 0.52; 95% confidence interval = 0.46 to 0.57) and good if using quadratic , (weighted ,= 0.66; 95% confidence interval = 0.60 to 0.71). ED overcrowding data were available for 353 patients (62.0%). Agreement did not significantly differ with respect to periods of ambulance diversion, number of admitted inpatients occupying stretchers, number of patients in the waiting room, number of patients registered in two hours, or nurse perception of busyness. Conclusions: This study demonstrated different agreement depending on the method used to calculate interrater reliability. Using the standard methods, it found good agreement between two independent users of a computerized triage tool. The level of agreement was not affected by various measures of ED crowding. [source] An observational cohort study of triage for critical care provision during pandemic influenza: ,clipboard physicians' or ,evidenced based medicine'?ANAESTHESIA, Issue 11 2009T. Guest Summary We assessed the impact of a United Kingdom government-recommended triage process, designed to guide the decision to admit patients to intensive care during an influenza pandemic, on patients in a teaching hospital intensive care unit. We found that applying the triage criteria to a current case-mix would result in 116 of the 255 patients (46%) admitted during the study period being denied intensive care treatment they would have otherwise received, of which 45 (39%) survived to hospital discharge. In turn, 69% of those categorised as too ill to warrant admission according to the criteria survived. The sensitivity and specificity of the triage category at ICU admission predicting mortality was 0.29 and 0.84, respectively. If the need for intensive care beds is estimated to be 275 patients per week, the triage criteria would not exclude enough patients to prevent the need for further rationing. We conclude that the proposed triage tool failed adequately to prioritise patients who would benefit from intensive care. [source] IS THE REVISED TRAUMA SCORE STILL USEFUL?ANZ JOURNAL OF SURGERY, Issue 11 2003Belinda J. Gabbe The revised trauma score (RTS) has been embraced by the trauma community worldwide. Although originally developed as a triage tool, the use of the RTS has since been expanded to include the prediction of outcome following traumatic injury. Through a critical review of the literature, evidence for use of the RTS is discussed along with the limitations of this commonly used tool. In summary, the RTS is a well-established predictor of mortality in trauma populations, but there is a lack of definitive evidence supporting its use as a primary triage tool and as a predictor of outcomes other than mortality. Difficulty in collecting the components of the RTS creates issues for data validity and the use of the RTS as a research tool. Although the weighted RTS has been developed to improve the prediction capacity of the RTS, studies reporting its use are few and there is debate regarding the applicability of the published coefficients for broad use. Overall, further studies are warranted to clearly establish the usefulness of the RTS as a triage tool in the field, to further evaluate the weighted version of the RTS, and to determine the ability of the RTS to predict functional outcome and quality of life. In particular, future research is needed to address these issues in Australian trauma populations. [source] Interrater Agreement between Nurses for the Pediatric Canadian Triage and Acuity Scale in a Tertiary Care CenterACADEMIC EMERGENCY MEDICINE, Issue 12 2008FRCPC, Jocelyn Gravel MD Abstract Objectives:, The objective was to measure the interrater agreement between nurses assigning triage levels to children visiting a pediatric emergency departments (EDs) assisted by a computerized version of the Pediatric Canadian Triage and Acuity Scale (PedCTAS). Methods:, This was a prospective cohort study evaluating children triaged from Level 2 (emergent) to Level 5 (nonurgent). A convenience sample of patients triaged during 38 shifts from April to September 2007 in a tertiary care pediatric ED was evaluated. All patients were initially triaged by regular triage nurses using a computerized version of the PedCTAS. Research nurses performed a second evaluation blinded to the first evaluation using the same triage tool. These research nurses were regular ED nurses performing extra hours for research purposes exclusively. The primary outcome measure was the interrater agreement between the two nurses as measured by the linear weighted kappa score. Secondary outcomes included the proportion of patient for which nurses did not apply the triage level suggested by Staturg (override) and agreement for these overrides. Results:, A total of 499 patients were recruited. The overall interrater agreement was moderate (linear weighted kappa score of 0.55 [95% confidence interval {CI} = 0.48 to 0.61] and quadratic weighted kappa score of 0.61 [95% CI = 0.42 to 0.80]). There was a discrepancy of more than one level in only 10 patients (2% of the study population). Overrides occurred in 23.2 and 21.8% for regular and research triage nurses, respectively. These overrides were equally distributed between increase and decrease in triage level. Conclusions:, Nurses using Staturg, which is a computerized version of the PedCTAS, demonstrated moderate interrater agreement for assignment of triage level to children presenting to a pediatric ED. [source] A systematic review of the features that indicate intentional scalds in childrenCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2009Richard Reading A systematic review of the features that indicate intentional scalds in children . MaguireS., MoynihanS., MannM., PotokarT. & KempA. M. ( 2008 ) Burns , 34 , 1072 , 1081 . DOI: 10.1016/j.burns.2008.02.011 . Background Most intentional burns are scalds, and distinguishing these from unintentional causes is challenging. Aim To conduct a systematic review to identify distinguishing features of intentional and unintentional scalds. Methods We performed an all language literature search of 12 databases 1950,2006. Studies were reviewed by two paediatric/burns specialists, using standardized methodology. Included: Primary studies of validated intentional or accidental scalds in children 0,18 years old and ranked by confirmation of intentional or unintentional origin. Excluded: Neglectful scalds; management or complications; studies of mixed burn type or mixed adult and child data. Results A total of 258 studies were reviewed, and 26 included. Five comparative studies ranked highly for confirmation of intentional/unintentional cause of injury. The distinguishing characteristics were defined based on best evidence. Intentional scalds were commonly immersion injuries, caused by hot tap water, affecting the extremities, buttocks or perineum or both. The scalds were symmetrical with clear upper margins, and associated with old fractures and unrelated injuries. Unintentional scalds were more commonly due to spill injuries of other hot liquids, affecting the upper body with irregular margins and depth. Conclusions We propose an evidence-based triage tool to aid in distinguishing intentional from unintentional scalds, requiring prospective validation. [source] | ||||||||||