• 한국산학기술학회논문지
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• 제19권11호
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• pp.626-634
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• 2018

본 연구는 한국형응급환자분류도구(Korean Triage and Acuity Scale: KTAS)를 사용한 소아 중증도 분류의 정확성을 파악하기 위한 후향적 조사연구이다. 연구자료는 2016년 10월부터 2017년 9월까지 1개 권역응급의료센터, 1개 지역응급의료센터에 방문한 소아환자의 자료 중 무작위로 추출한 250건의 간호초진기록지와 진료결과였다. 수집된 자료를 검정된 전문가가 분석하여 true-triage를 정하였다. 중증도 분류 정확도는 응급실간호사의 중증도 분류 결과와 전문가의 true-triage결과와의 일치도로 평가하였다. 전문가 의견에 따라 중증도 분류 오류의 원인이 분석되었고, KTAS 등급과 퇴원, 체류시간, 진료비와의 연관성이 비교되었다. 연구결과 전문가와 응급실 간호사의 중증도 분류 등급은 높은 일치도를 보였다(weighted kappa=.77). 중증도 분류 불일치의 원인 중 활력징후 결과를 KTAS 알고리즘 기준에 잘 못 적용한 경우가 가장 많았다(n=13). KTAS 1,2 등급과 같이 중증도가 높을수록 퇴원이 적었다(${\chi}=43.25$, p<.001). 연령을 보정했을 때 KTAS 등급에 따라 체류시간(F=12.39, p<.001)과 진료비(F=11.78, p<.001)는 차이가 있었다. 본 연구결과 KTAS는 국내 응급실에서 높은 정확도를 보였으므로, 새로 개발된 중증도 분류 도구가 국내 응급실에 잘 적용되고 있다고 할 수 있다.

• 융합정보논문지
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• 제10권4호
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• pp.98-103
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• 2020

본 연구에서는 KTAS(Korean Triage and Acuity Scale) 결과가 분류를 시행한 주체의 직종에 따른 차이가 있는지를 알아보고자 한다. 2016년 1월 1일부터 2017년 12월 31일까지의 응급의료기관으로 내원한 환자 자료 중, 국가응급진료정보망으로 전송된 자료 총 10,960,359건을 분석하였다. 분류자 직종은 전문의, 전공의, 인턴, 일반의, 간호사, 응급구조사였다. 최초 중증도 분류와 최종 중증도 분류 결과의 일치율은 일반의가 98.9%로 가장 높았고, 인턴이 80.2%로 가장 낮았다. 과대 분류에서는 일반의가 0.6%로 가장 낮았고, 인턴은 16.0%로 가장 높았다. 또한 과소 분류는 전문의와 응급구조사가 0.4%로 가장 낮았고, 인턴이 3.8%로 가장 높았다. 중증도 분류 결과는 직종별 유의미한 차이가 있었다(p<0.001). 중증도 분류는 환자의 예후에 영향을 미치는 요인 중 하나로 직종별, 숙련도에 따라 그 결과가 달라져서는 안 된다. 때문에 정확한 중증도 분류를 위한 분류자의 역량 강화가 필요하다.

• 한국응급구조학회지
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• 제25권3호
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• pp.71-80
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• 2021

Purpose: The purpose of this study is to investigate the characteristics and appropriateness of the Korean-type severity classification by ambulance based on the medical records of 43,561 emergency patients who were brought to the emergency medical center via ambulance between January 1, 2015 and December 31, 2017. Methods: This study analyzed the classification characteristics of the Korean severity classification tool by applying them to emergency patients who visited the emergency medical center. Results: As a result of the study first, among the categories of home hospitals according to the results of visits, "other," "low consciousness," and "dyspnea" in the order of 129 ambulances were statistically significantly higher. In the order of "low consciousness" and "trauma," the "trauma" category was 5.3% higher than that of 129 ambulances. Conclusion: Among the classification items, "others," "low consciousness," and "dyspnea" were significantly higher in the group of patients who boarded 129 ambulances, and "others," "low consciousness," and "traumatic" were significantly higher in the 119 ambulances.

• 디지털융복합연구
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• 제17권2호
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• pp.217-230
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• 2019

본 연구는 기존 동반질환을 이용한 중증도 보정 방법의 제한점을 보완하기 위해 급성심근경색증 환자의 맞춤형 중증도 보정방법을 개발하고, 이의 타당성을 평가하기 위해 수행되었다. 이를 위하여 질병관리본부에서 2006년부터 2015년까지 10년간 수집한 퇴원손상심층조사 자료 중 주진단이 급성심근경색증인 한국표준질병사인분류(KCD-7) 코드 I20.0~I20.9의 대상자를 추출하였고, 동반질환 중증도 보정 도구로는 기존 활용되고 있는 CCI(Charlson comorbidity index), ECI(Elixhauser comorbidity index)와 새로이 제안하는 CCS(Clinical Classification Software)를 사용하였다. 이에 대한 중증도 보정 사망예측모형 개발을 위하여 머신러닝 기법인 로지스틱 회귀분석, 의사결정나무, 신경망, 서포트 벡터 머신기법을 활용하여 비교하였고 각각의 AUC(Area Under Curve)를 이용하여 개발된 모형을 평가하였다. 이를 평가한 결과 중증도 보정도구로는 CCS 가 가장 우수한 것으로 나타났으며, 머신러닝 기법 중에서는 서포트 벡터 머신을 이용한 모형의 예측력이 가장 우수한 것으로 확인되었다. 이에 향후 의료서비스 결과평가 등 중증도 보정을 위한 연구에서는 본 연구에서 제시한 맞춤형 중증도 보정방법과 머신러닝 기법을 활용하도록 하는 것을 제안한다.

• 한국컴퓨터정보학회논문지
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• 제16권1호
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• pp.175-182
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• 2011

본 연구에서는 환자의 중증도 분류 및 인체 주요 장기의 상태 예측을 위하여 APACHE II(Acute Physiology And Chronic Health Evaluation) 기반 CDSS 도구인 CAOPI(Computer Aided Organ Prediction Index) 시스템을 제안한다. 기존 ICU 환자의 중증도 평가방법은 APACHE II를 이용하여 특정 시점의 중환자 위험도를 특정한 시점 데이터를 이용하여 산출하는 방식이었으나, 실시간으로 변화하는 환자의 상태에 맞춰 조치를 취하는데는 한계가 있다. CAOPI 시스템은 중환자실에 입실하는 환자들의 질병 중증도를 정확히 분류하고, 환자의 사망예측 뿐만 아니라장기 상태를 시각화 하여 위험도를 수치화 하였다. 또한 위험도를 특정 장기별로 구분하여 담당의 사가 환자의 상태에 맞는 맞춤형 응급조치를 취할 수 있도록 설계 및 개발 하였다.

• 임상간호연구
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• 제24권1호
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• pp.94-102
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• 2018

Purpose: The purpose of this study was to examine triage nurses' the Korean triage and acuity scale(KTAS) performance ability, perception of importance, education needs and identify the factors influencing triage nurses' the KTAS performance ability. Methods: A descriptive correlational study was conducted among 146 emergency nurses working in 13 hospitals from March to May, 2017. Data were collected utilizing a questionnaire developed to measure performance ability, perception of importance, and educational needs of 192 items of the KTAS. Statistical analysis included t-test, analysis of variance, correlation analysis and multiple regression analysis. Results: The triage nurses' the KTAS performance ability was rated as 3.3/4.0 points, perception of importance as 3.2/4.0 points, and education needs as 3.1/4.0 points. Factors influencing the KTAS performance of the participants were perception of importance, education needs, and work experience at the emergency department, explaining 26.7% of total variance. Conclusion: The KTAS performance ability of triage nurses could be improved through training programs designed to enhance their perception of importance and provide knowledge about the KTAS. Nurses' emergency department work experience needs to be considered as an important factor for the KTAS performance ability.

• 동서간호학연구지
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• 제26권1호
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• pp.91-99
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• 2020

Purpose: The study aims to assess the inter-rater reliability of the Korean Triage and Acuity Scale between the research nurses and the triage nurses. Methods: Interrater reliability was measured on 400 adult (≧15) and 400 pediatric (<15) patients who visited the emergency medical center from January 4 to June 30, 2018. Results: The study result showed that the inter-rater reliability of the Korean Triage and Acuity Scale was substantial, with κ=.73 (95% Confidence interval= .68-.78) and 77.0 percent agreement. The inter-rater of Pediatric Korean Triage and Acuity Scale was also substantial, with κ=.76 (95% Confidence interval= .71-.82) and 83.8 percent agreement. Conclusion: Although the inter-rater reliability of the Korean Triage and Acuity Scale was acceptable, the percent agreement was lower than the desirable level (<80.0%). It was confirmed that Pediatric Korean Triage and Acuity Scale had an acceptable level of inter-rater reliability and percent agreement for clinical use. Efforts should be made to improve the reliability in the future.

• 대한간호학회지
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• 제49권1호
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• pp.26-35
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• 2019

Purpose: The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS). Methods: This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value. Results: In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively. Conclusion: The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.

• 임상간호연구
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• 제26권1호
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• pp.107-116
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• 2020

Purpose: This study was a prospective survey to evaluate the Korean Triage and Acuity Scale (KTAS) inter-rater reliability and to identify discordant areas in the KTAS classification between nurses and paramedics in emergency department (ED). Methods: Inter-rater reliability were evaluated using triage deta from January 11 to May 31, 2019. A convinience sample of a total of 800 patients who visited an emergnecy medical center in Incheon (400 adult and 400 pediatric patients in this study) were selected. The triages of this study a pair of one nurse and one paramedic performed triage at the same time, using the KTAS, Inter-rater reliability for the KTAS was evaluated with the weighted kappa. Results: The inter-rater reliability of the KTAS evaluated by weighted Kappa between nurse-paramedic KTAS score of adult patients was .71, and .66 for pediatric patients. Both were in the level considered as substantial. Among causes of triage discordance, the most frequently identified discordant item in triaging adults was the difference in the measurement of pain intensity (28.0%). For both adult and pediatric patients, multiple chief complaint was identified as the major discordant factor. In triaging pediatric patients the body temperature assessment by subjective judgments was the highest discordant item (50.7%). Conclusion: The study result suggested that the KTAS demonstrated a reasonable level of inter-rater reliability and functioned as a standardized triage tool for emergency medical services. In order to improve the inter-rater reliability and classification competence, it is necessary to revise the current all-integrated KTAS provider course to be differentiated for each job group.

• 임상간호연구
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• 제26권3호
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• pp.395-406
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• 2020

Purpose: The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. Methods: The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. Results: Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. Conclusion: Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.