The Copenhagen Triage Algorithm is non-inferior to a traditional triage algorithm: A cluster-randomized study.

Autor: Hasselbalch RB; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark., Pries-Heje M; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark., Schultz M; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark., Plesner LL; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark., Ravn L; Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark., Lind M; Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark., Greibe R; Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark., Jensen BN; Department of Emergency Medicine, Bispebjerg Hospital, Copenhagen, Denmark., Høi-Hansen T; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark., Carlson N; Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.; The Danish Heart Foundation, Copenhagen, Denmark., Torp-Pedersen C; Department of Health, Science and Technology, Aalborg University and Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, Denmark., Rasmussen LS; Department of Anaesthesia, Center of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Iversen K; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark.; Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2019 Feb 04; Vol. 14 (2), pp. e0211769. Date of Electronic Publication: 2019 Feb 04 (Print Publication: 2019).
DOI: 10.1371/journal.pone.0211769
Abstrakt: Introduction: Triage systems with limited room for clinical judgment are used by emergency departments (EDs) worldwide. The Copenhagen Triage Algorithm (CTA) is a simplified triage system with a clinical assessment.
Methods: The trial was a non-inferiority, two-center cluster-randomized crossover study where CTA was compared to a local adaptation of Adaptive Process Triage (ADAPT). CTA involves initial categorization based on vital signs with a final modification based on clinical assessment by an ED nurse. We used 30-day mortality with a non-inferiority margin at 0.5%. Predictive performance was compared using Receiver Operator Characteristics.
Results: We included 45,347 patient visits, 23,158 (51%) and 22,189 (49%) were triaged with CTA and ADAPT respectively with a 30-day mortality of 3.42% and 3.43% (P = 0.996) a difference of 0.01% (95% CI: -0.34 to 0.33), which met the non-inferiority criteria. Mortality at 48 hours was 0.62% vs. 0.71%, (P = 0.26) and 6.38% vs. 6.61%, (P = 0.32) at 90 days for CTA and ADAPT. CTA triaged at significantly lower urgency level (P<0.001) and was superior in predicting 30-day mortality, Area under the curve: 0.67 (95% CI 0.65-0.69) compared to 0.64 for ADAPT (95% CI 0.62-0.66) (P = 0.03). There were no significant differences in rate of admission to the intensive care unit, length of stay, waiting time nor rate of readmission within 30 or 90 days.
Conclusion: A novel triage system based on vital signs and a clinical assessment by an ED nurse was non-inferior to a traditional triage algorithm by short term mortality, and superior in predicting 30-day mortality.
Trial Registration: Clinicaltrials.gov NCT02698319.
Competing Interests: Dr. Torp-Pedersen reports grants and personal fees from Bayer, grants from Biotronic, outside the submitted work.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje