Relevance of emergency level assessment by the Korean Triage and Acuity Scale for adult patients in a local emergency medical center

  • Lee, Gun Woo (Department of Emergency Medicine, Catholic University of Daegu School of Medicine) ;
  • Lee, Suk Hee (Department of Emergency Medicine, Catholic University of Daegu School of Medicine) ;
  • Lee, Kyung-Woo (Department of Emergency Medicine, Catholic University of Daegu School of Medicine) ;
  • Jang, Tae Chang (Department of Emergency Medicine, Catholic University of Daegu School of Medicine) ;
  • Kim, Gyun Moo (Department of Emergency Medicine, Catholic University of Daegu School of Medicine) ;
  • Seo, Young Woo (Department of Emergency Medicine, Catholic University of Daegu School of Medicine) ;
  • Ko, Seung Hyun (Department of Emergency Medicine, Catholic University of Daegu School of Medicine)
  • ;
  • 이숙희 (대구가톨릭대학교 의과대학 응급의학교실) ;
  • ;
  • ;
  • ;
  • ;
  • Received : 2018.05.04
  • Accepted : 2018.10.02
  • Published : 2018.12.31

Abstract

Objective: The Korean Triage and Acuity Scale (KTAS), which was implemented in 2016, needs to be assessed for its validity and reliability. Here we evaluate the relevance of emergency level assessment by analyzing the validity of KTAS as a Korean standardized triage system. Methods: We retrospectively analyzed the medical records of adults who presented to a local emergency room (ER) during an 18-month period. We compared medical resources used, life-saving interventions performed, length of stay (LOS) in ER, admission rate, and mortality at each KTAS level. Results: Among a total of 40,339 patients, most patients were at KTAS 4 (n=19,532, 48.4%) and the longest median LOS in ER was 450 minutes at KTAS 2. As the KTAS level increased, the percentage of medical resources used and lifesaving interventions performed increased significantly. The odds of total admission and intensive care unit admission were significantly higher at KTAS 1 through 4 compared to those at KTAS 5. The odds related to admission and mortality were also significantly higher at KTAS 3 than at KTAS 4. Conclusion: We concluded that the KTAS, as a Korean standardized triage system of emergency level assessment, is relevant. Further, KTAS 1-3 and KTAS 4-5 are appropriate criteria to distinguish emergency and non-emergency patients.

Keywords

References

  1. Lentz BA, Jenson A, Hinson JS, et al. Validity of ED: Addressing heterogeneous definitions of over-triage and under-triage. Am J Emerg Med 2017;35:1023-5. https://doi.org/10.1016/j.ajem.2017.02.012
  2. Lee KH, Cho SJ, Lee JE, et al. Study for standardization of Korean triage and acuity scale. Sejong: Ministry of Health and Welfare; 2012.
  3. Lim TH, Lee KH, Cho SJ, et al. Assessment for validity and reliability of Korean triage and acuity scale. Sejong: Ministry of Health and Welfare; 2015.
  4. Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Acad Emerg Med 2000;7:236-42. https://doi.org/10.1111/j.1553-2712.2000.tb01066.x
  5. Shin JW, Lee SH, Lee DS, et al. Validity of the newly developed five level pediatric triage system implemented in a children's hospital emergency department. J Korean Soc Emerg Med 2017;28:557-63.
  6. PRISM [Internet]. Seoul: Ministry of the Interior and Safety; 2018 [cited 2018 Aug 15]. Available from: http://www.prism.go.kr/.
  7. American College of Surgeons' Committee on Trauma. Advanced trauma life support (ATLS). 9th ed. Chicago, IL: American College of Surgeons; 2015.
  8. 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.
  9. Park J, Lim T. Korean Triage and Acuity Scale (KTAS). J Korean Soc Emerg Med 2017;28:547-51.
  10. Twomey M, Wallis LA, Myers JE. Limitations in validating emergency department triage scales. Emerg Med J 2007;24:477-9. https://doi.org/10.1136/emj.2007.046383
  11. 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
  12. Mowery NT, Dougherty SD, Hildreth AN, et al. Emergency department length of stay is an independent predictor of hospital mortality in trauma activation patients. J Trauma 2011;70:1317-25. https://doi.org/10.1097/TA.0b013e3182175199
  13. Zachariasse JM, Seiger N, Rood PP, et al. Validity of the Manchester Triage System in emergency care: a prospective observational study. PLoS One 2017;12:e0170811. https://doi.org/10.1371/journal.pone.0170811
  14. Gravel J, Manzano S, Arsenault M. Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital. CJEM 2009;11:23-8. https://doi.org/10.1017/S1481803500010885
  15. Seiger N, van Veen M, Steyerberg EW, van der Lei J, Moll HA. Accuracy of triage for children with chronic illness and infectious symptoms. Pediatrics 2013;132:e1602-8. https://doi.org/10.1542/peds.2013-1076