Journal of The Korean Society of Emergency Medicine (대한응급의학회지)

The Korean Society of Emergency Medicine (대한응급의학회)
권호 표지

Comparison with in-hospital Korean Triage and Acuity Scale (KTAS) and prehospital triage system in a metropolitan city

일개 대도시의 병원전 단계와 병원 단계의 중증도 분류체계 간의 결과 분석

  • Choi, Hyo Jeong (Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Ho Jung (Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Hyo Ju (Department of Emergency Medical Technology, Sun Moon University) ;
  • Lee, Bo Ra (Department of Statistics, Graduate School of Chung-Ang University)
  • 최효정 (순천향대학교 부천병원 응급의학과) ;
  • 김호중 (순천향대학교 부천병원 응급의학과) ;
  • 이효주 (선문대학교 응급구조학과) ;
  • 이보라 (중앙대학교 대학원 통계학과)
  • Received : 2018.05.18
  • Accepted : 2018.08.10
  • Published : 2018.10.31

⟨ Previous Next ⟩

Abstract

Objective: This study was conducted to analyze and compare the classifications of a prehospital triage system and an in-hospital triage system. Methods: The records of patients transferred from the '119' emergency service for 5 months (from January 1 to May 31, 2016) were collected and records of first aid activities were assessed. We examined cases classified as four (urgent, semi-urgent, potentially urgent, and non-urgent) of five stages, excluding death. In the hospital, data were collected from medical records and classifications made using the five Korean Triage and Acuity Scale (KTAS) stages (1, resuscitation; 2, emergency; 3, urgent; 4, less urgent; and 5, non-urgent) were analyzed. Results: The number of patients enrolled in the study was 3,457. Of them, 2,301 were discharged after treatment and 1,156 were hospitalized. According to the prehospital triage classification, 726 of the 3,457 cases were urgent, 593 were semi-urgent, 1,944 were potentially urgent, and 194 were non-urgent. The results of the in-hospital triage were as follows: 114 KTAS 1 (3.3%), 491 KTAS 2 (14.2%), 1,345 KTAS 3 (38.9%), 1,227 KTAS 4 (35.5%), and 280 KTAS 5 (8.1%). The odds ratio trend for hospitalization showed a larger decrease according to in-hospital staging (95% CI, 0.32-0.39) than according to prehospital staging (95% CI, 0.50-0.60). The odds ratio trend for intensive care unit (ICU) admission also showed a larger decrease according to in-hospital staging (95% CI, 0.16-0.22) than according to prehospital staging (95% CI, 0.37-0.48). Conclusion: We found little correspondence in classifications made according to the KTAS and prehospital triage systems. However, the tendencies toward decreases in the hospitalization and ICU admission rates were similar.

Keywords

References

  1. Hardern RD. Critical appraisal of papers describing triage systems. Acad Emerg Med 1999;6:1166-71. https://doi.org/10.1111/j.1553-2712.1999.tb00121.x
  2. Lee KH. How to developed and use the KTAS (Korean Triage and Acuity Scale). Korean Soc Emerg Med Meet Abstr 2013;2013:417-24.
  3. National Emergency Management Agency. The standard protocols for 119 emergency medical services providers. Seoul: National Emergency Management Agency; 2013.
  4. Lowthian JA, Curtis AJ, Cameron PA, Stoelwinder JU, Cooke MW, McNeil JJ. Systematic review of trends in emergency department attendances: an Australian perspective. Emerg Med J 2011;28:373-7. https://doi.org/10.1136/emj.2010.099226
  5. Brown LH, Hubble MW, Cone DC, et al. Paramedic determinations of medical necessity: a meta-analysis. Prehosp Emerg Care 2009;13:516-27. https://doi.org/10.1080/10903120903144809
  6. Gratton MC, Ellison SR, Hunt J, Ma OJ. Prospective determination of medical necessity for ambulance transport by paramedics. Prehosp Emerg Care 2003;7:466-9. https://doi.org/10.1080/31270300220X
  7. Levine SD, Colwell CB, Pons PT, Gravitz C, Haukoos JS, McVaney KE. How well do paramedics predict admission to the hospital? A prospective study. J Emerg Med 2006;31:1-5. https://doi.org/10.1016/j.jemermed.2005.08.007
  8. Silvestri S, Rothrock SG, Kennedy D, Ladde J, Bryant M, Pagane J. Can paramedics accurately identify patients who do not require emergency department care? Prehosp Emerg Care 2002;6:387-90. https://doi.org/10.1080/10903120290937987
  9. Smith DT, Snyder A, Hollen PJ, Anderson JG, Caterino JM. Analyzing the usability of the 5-level Canadian triage and acuity scale by paramedics in the prehospital environment. J Emerg Nurs 2015;41:489-95. https://doi.org/10.1016/j.jen.2015.03.006
  10. Ackroyd-Stolarz S, Read Guernsey J, Mackinnon NJ, Kovacs G. The association between a prolonged stay in the emergency department and adverse events in older patients admitted to hospital: a retrospective cohort study. BMJ Qual Saf 2011;20:564-9. https://doi.org/10.1136/bmjqs.2009.034926
  11. Bullard MJ, Villa-Roel C, Bond K, Vester M, Holroyd BR, Rowe BH. Tracking emergency department overcrowding in a tertiary care academic institution. Healthc Q 2009;12:99-106. https://doi.org/10.12927/hcq.2013.20884
  12. Kulstad EB, Sikka R, Sweis RT, Kelley KM, Rzechula KH. ED overcrowding is associated with an increased frequency of medication errors. Am J Emerg Med 2010;28:304-9. https://doi.org/10.1016/j.ajem.2008.12.014
  13. Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ 2011;342:d2983. https://doi.org/10.1136/bmj.d2983
  14. Land L, Meredith N. An evaluation of the reasons why patients attend a hospital Emergency Department. Int Emerg Nurs 2013;21:35-41. https://doi.org/10.1016/j.ienj.2011.12.001
  15. McCusker J, Vadeboncoeur A, Levesque JF, Ciampi A, Belzile E. Increases in emergency department occupancy are associated with adverse 30-day outcomes. Acad Emerg Med 2014;21:1092-100. https://doi.org/10.1111/acem.12480
  16. Kim JH, Kim JW, Kim SY, et al. Validation of the Korean Triage and Acuity Scale compare to triage by Emergency Severity Index for emergency adult patient: preliminary study in a tertiary hospital emergency medical center. J Korean Soc Emerg Med 2016;27:436-41.
  17. Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 2003;20:402-5. https://doi.org/10.1136/emj.20.5.402
  18. Jenkin A, Abelson-Mitchell N, Cooper S. Patient handover: time for a change? Accid Emerg Nurs 2007;15:141-7. https://doi.org/10.1016/j.aaen.2007.04.004
  19. Fraess-Phillips AJ. Can paramedics safely refuse transport of non-urgent patients? Prehosp Disaster Med 2016;31:667-74. https://doi.org/10.1017/S1049023X16000935
  20. Storm-Versloot MN, Ubbink DT, Kappelhof J, Luitse JS. Comparison of an informally structured triage system, the emergency severity index, and the manchester triage system to distinguish patient priority in the emergency department. Acad Emerg Med 2011;18:822-9. https://doi.org/10.1111/j.1553-2712.2011.01122.x
  21. Eitel DR, Travers DA, Rosenau AM, Gilboy N, Wuerz RC. The Emergency Severity Index triage algorithm version 2 is reliable and valid. Acad Emerg Med 2003;10:1070-80. https://doi.org/10.1197/S1069-6563(03)00350-6
  22. Tanabe P, Gimbel R, Yarnold PR, Kyriacou DN, Adams JG. Reliability and validity of scores on The Emergency Severity Index version 3. Acad Emerg Med 2004;11:59-65. https://doi.org/10.1111/j.1553-2712.2004.tb01371.x
  23. Ha SO, Lim KS, Kim W, Oh BJ. Clinical characteristics and worsening prognosis for undertriage patients in the emergency department: a university affiliated hospital observational study. J Korean Soc Emerg Med 2011;22:701-8.