Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

Abstract

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed:1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED?2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)?3. How valid is each triage scale in predicting hospitalization and hospital mortality?A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted.We found ED triage scales to be supported, at best, by limited and often insufficient evidence.The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

“…Over the years, a number of ED triage scales have been created, revised, implemented, and studied in attempts to ensure the accuracy of triage categorization. [1][2][3][4][5][6][7] Vital signs are often included in triage assessments and help guide triage classification and resultant timeliness of provider evaluation.…”

Avaliação da qualidade da Classificação de Risco nos Serviços de Emergência

“…For this reason, different systems have been developed worldwide to support nurses in better classifying the severity of each case. (1,2) In general, these classification systems aim to reduce the time that patients have to wait in hospital emergency departments by prioritizing more severe cases in which an obscure prognosis can lead to a delay in treatment. (1) Internationally, the most used screening systems for risk classification are the Australian Triage Scale, Canadian Emergency Department Triage and Acuity Scale, Manchester Triage Scale, and the Emergency Severity Index.…”

“…(1,2) In general, these classification systems aim to reduce the time that patients have to wait in hospital emergency departments by prioritizing more severe cases in which an obscure prognosis can lead to a delay in treatment. (1) Internationally, the most used screening systems for risk classification are the Australian Triage Scale, Canadian Emergency Department Triage and Acuity Scale, Manchester Triage Scale, and the Emergency Severity Index. (1) In Brazil, the government has been recommending the screening system Embracement with Risk Classification since 2004.…”

“…(1) Internationally, the most used screening systems for risk classification are the Australian Triage Scale, Canadian Emergency Department Triage and Acuity Scale, Manchester Triage Scale, and the Emergency Severity Index. (1) In Brazil, the government has been recommending the screening system Embracement with Risk Classification since 2004.…”

Diagnosticos de enfermagem em pacientes classificados nos niveis I e II de prioridade do Protocolo Manchester

“…Attributing the degree of risk that a given patient involves a complex process of decision-making and use of several screening scales that have been developed to guide nursing assessment (4,5) . Classification protocols enable different evaluators to conduct clinical investigations using the same parameters in order to establish the severity of a patient's condition and, as a result, decrease the potential for bias from the subjective view of each evaluator.…”