Abstract
Amaç: Triyaj acil tıbbi bakımı bekleyebilecek olanlar ile bekleyemeyecek olanların ayrılması için yapılan uygulamadır. Mortaliteyi öngörmek için fizyolojik parametreler de dahil olmak üzere skorlama sistemleri tanımlanmıştır, ancak acil servislerde kullanılan çoğu triyaj yönteminde, vital bulgular veya laboratuvar parametreler standart değerlendirmeler olarak dahil edilmemiştir. Bu çalışmanın amacı, acil servise başvuran hastaların triyaj kararını farklı sağlık çalışanları arasındaki uyuşmalarını ölçmektir. Ayrıca, farklı parametrelerle modlar oluşturarak hangi vital bulguların ve parametrelerin triyaj kararını etkilediğini belirlemeyi amaçladık.
Gereç ve Yöntem: Bu prospektif çalışma, bir akademik acil servise başvuran 550 hasta üzerinde gerçekleştirildi. Hastaların triyaj düzeyleri hemşireler, stajyer doktorlar, asistanlar ve acil tıp uzmanları tarafından belirlendi. Farklı parametreler içeren 11 mod belirlenmiştir ve her mod için 50 hasta tanımlanmıştır. Uygulayıcıların triyaj kararları arasındaki anlaşmayı değerlendirmek için, kappa uyumluluk testi kullanılmıştır.
Bulgular: Çalışmaya dahil edilen 550 hasta için, kappa uyumluluk değeri hemşireler için 0,374, intörn doktorların; 257, asistanlar için 0,311 bulunmuştur.
Sonuç: Acil tıpta, acil servise kabul edilen hastaları tanımlamak için hassas araçlara güçlü bir ihtiyaç vardır. Sonuçlarımıza göre triyaj kararını etkileyen en önemli parametreler oksijen satürasyonu ve Glasgow Koma skalası olduğu tespit edilmiştir.
Ethical Statement
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Supporting Institution
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Project Number
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Thanks
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References
- 1. Moll HA. Challenges in the validation of triage systems at emergency departments. J Clin Epidemiol 2010;63:384-388.
- 2. Travers DA, Wller AE, Bowling JM, et al. Five-level triage system more effective than three-level in tertiary emergency department. J Emerg Nurs 2002;28:395-400.
- 3. Erimşah ME, Yaka E, Yilmaz S, et al. Inter-rater reliability and validity of the Ministry of Health of Turkey’s mandatory emergency triage instrument. Emerg Med Australas 2015;27:210-215.
- 4. Alquraini M, Awad E, Hijazi R. Reliability of Canadian Emergency Department Triage and Acuity Scale (CTAS) in Saudi Arabia. Int J Emerg Med 2015;8:80.
- 5. Cooper RJ, Schriger DL, Flaherty HL, et al. Effect of vital signs on triage decisions. Ann Emerg Med 2002;39:223-232.
- 6. Durand AC, Gentile S, Gerbeaux P, et al. Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France. BMC Emerg Med 2011;11:19.
- 7. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22:276-282.
- 8. Garbez R, Carrieri-Kohlman V, Stotts N, et al. Factors influencing patient assignment to level 2 and level 3 within the 5-level ESI triage system. J Emerg Nurs 2011;37:526-532.
- 9. Baumann MR, Strout TD. Evaluation of the Emergency Severity Index (version 3) triage algorithm in pediatric patients. Acad Emerg Med 2005;12:219-224.
- 10. Olsson T, Terent A, Lind L. Rapid Emergency Medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med 2004;255:579-587.
- 11. Widgren BR, Jourak M. Medical Emergency Triage and Treatment System (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med 2011;40:623-628.
- 12. Brillman JC, Doezema D, Tandberg D, et al. Triage: limitations in predicting need for emergent care and hospital admission. Ann Emerg Med 1996;27:493-500.
- 13. Caterino JM, Holliman CJ, Kunselman AR. Underestimation of case severity by emergency department patients: implications for managed care. Am J Emerg Med 2000;18:254-256.
- 14. Farrohknia N, Castrén M, Ehrenberg A, et al. Emergency department triage scales and their components: a systematic review of the scientific evidence. Scand J Trauma Resusc Emerg Med 2011;19:42.
- 15. Read S, George S, Westlake L, et al. Piloting an evaluation of triage. Int J Nurs Stud 1992;29:275-288.
- 16. Gerdtz MF, Bucknall TK. Triage nurses’ clinical decision making. An observational study of urgency assessment. J Adv Nurs 2001;35:550-561.
- 17. Goodacre S, Turner J, Nicholl J. Prediction of mortality among emergency medical admissions. Emerg Med J 2006;23:372-375.
- 18. George S, Read S, Westlake L, et al. Differences in priorities assigned to patients by triage nurses and by consultant physicians in accident and emergency departments. J Epidemiol Community Health 1993;47:312-315.
Abstract
Objectives: Triage aims to determine the clinical priority of patients based on their presenting features. Scoring systems-including physiological parameters-to predict mortality have been described, but in most triage methods used in emergency departments, vital signs or laboratory parameters are not included as standard assessments. The objective of this study was to measure agreement and acuity on the urgency of an emergency department patient between the points of views of healthcare professionals. We also sought to determine which vital signs and parameters affect triage decision by creating several mods with different parameters.
Materials and Methods: This prospective study was carried out on 550 patients referred to an academic emergency department. The patients triage levels were determined by nurses, intern doctors, residents and emergency physicians. Eleven mods were defined with several components, for each mod 50 patients were selected. To evaluate the agreement between raters triage decisions, the chance-adjusted measure of agreement kappa was calculated.
Results: Of the 550 patients included in the study, agreement for nurses was 0.374, kappa value between interns and physician was 0.257, and a value of 0.311 was found for residents.
Conclusion: In emergency medicine, there is a strong need for sensitive tools to identify and characterize patients at admission to the emergency department. According to our results, the most important parameters affecting triage decision were found to be oxygen saturation and Glasgow Coma scale
Ethical Statement
This study was approved by the Ankara University Faculty of Medicine Ethics Committee (approval number: 13-629-16).
Supporting Institution
-
Project Number
-
Thanks
-
References
- 1. Moll HA. Challenges in the validation of triage systems at emergency departments. J Clin Epidemiol 2010;63:384-388.
- 2. Travers DA, Wller AE, Bowling JM, et al. Five-level triage system more effective than three-level in tertiary emergency department. J Emerg Nurs 2002;28:395-400.
- 3. Erimşah ME, Yaka E, Yilmaz S, et al. Inter-rater reliability and validity of the Ministry of Health of Turkey’s mandatory emergency triage instrument. Emerg Med Australas 2015;27:210-215.
- 4. Alquraini M, Awad E, Hijazi R. Reliability of Canadian Emergency Department Triage and Acuity Scale (CTAS) in Saudi Arabia. Int J Emerg Med 2015;8:80.
- 5. Cooper RJ, Schriger DL, Flaherty HL, et al. Effect of vital signs on triage decisions. Ann Emerg Med 2002;39:223-232.
- 6. Durand AC, Gentile S, Gerbeaux P, et al. Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France. BMC Emerg Med 2011;11:19.
- 7. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22:276-282.
- 8. Garbez R, Carrieri-Kohlman V, Stotts N, et al. Factors influencing patient assignment to level 2 and level 3 within the 5-level ESI triage system. J Emerg Nurs 2011;37:526-532.
- 9. Baumann MR, Strout TD. Evaluation of the Emergency Severity Index (version 3) triage algorithm in pediatric patients. Acad Emerg Med 2005;12:219-224.
- 10. Olsson T, Terent A, Lind L. Rapid Emergency Medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med 2004;255:579-587.
- 11. Widgren BR, Jourak M. Medical Emergency Triage and Treatment System (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med 2011;40:623-628.
- 12. Brillman JC, Doezema D, Tandberg D, et al. Triage: limitations in predicting need for emergent care and hospital admission. Ann Emerg Med 1996;27:493-500.
- 13. Caterino JM, Holliman CJ, Kunselman AR. Underestimation of case severity by emergency department patients: implications for managed care. Am J Emerg Med 2000;18:254-256.
- 14. Farrohknia N, Castrén M, Ehrenberg A, et al. Emergency department triage scales and their components: a systematic review of the scientific evidence. Scand J Trauma Resusc Emerg Med 2011;19:42.
- 15. Read S, George S, Westlake L, et al. Piloting an evaluation of triage. Int J Nurs Stud 1992;29:275-288.
- 16. Gerdtz MF, Bucknall TK. Triage nurses’ clinical decision making. An observational study of urgency assessment. J Adv Nurs 2001;35:550-561.
- 17. Goodacre S, Turner J, Nicholl J. Prediction of mortality among emergency medical admissions. Emerg Med J 2006;23:372-375.
- 18. George S, Read S, Westlake L, et al. Differences in priorities assigned to patients by triage nurses and by consultant physicians in accident and emergency departments. J Epidemiol Community Health 1993;47:312-315.
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Articles |
| Authors | |
| Project Number | - |
| Publication Date | October 10, 2018 |
| Published in Issue | Year 2018 Volume: 71 Issue: 2 |
