Prognostic value of a four-level Chinese emergency triage for an Emergency Department: A prospective cohort study

Abstract

Background In order to assign treatment priorities of patients who presenting to emergency departments (ED), various triage scales have been developed around the world. In china, four-tier triage scale was recommended by a national triage guideline that published by the central Chinese government. After that a four-tier triage system, used only in tertiary hospitals in Shenzhen, was published by the Public Hospital Administration of Shenzhen Municipalitfy in August, 2013 (Shenzhen Triage System, SZTS). But the ability in predicting admission and in-hospital mortality with the four-level triage scale for patients presented in emergency department was unclear. This research aimed to assess the prognostic value of the SZTS by examining the association between triage levels and clinical outcomes in adult patients.Methods Patients 18 years of age or older, who were triaged category 1, 2 or 3 in the emergency department (ED) from May 17, 2017 until September 27, 2017, were enrolled. This study evaluated an association between triage level and in-hospital mortality, ICU admission and general ward admission by using multivariable logistic regression analysis. Receiver operating characteristic curves were used to assess the predictive ability of SZTS in determining in-hospital mortality, ICU admission and general ward admission.Results There were 383 patients enrolled in the study. More urgent triage level were significantly related to a higher proportion of in-hospital mortality, ICU admission and general ward admission. The OR for in-hospital mortality (OR 11.6, 95% CI 5.8-22.9, p<0.001), ICU admission (OR 14.4, 95% CI 7.4-27.7, p<0.001) and general ward admission (OR 10.6, 95% CI 1.4-79.2, p=0.022) were greater at triage level 1 compared to triage level 2 and level 3. The AUC for in-hospital mortality, ICU admission and general ward admission prediction of SZTS was 0.838, 0.830 and 0.792, respectively.Conclusions This study suggests that triage levels were associated with general ward admission, ICU admission and in-hospital mortality, and SZTS showed good performance for clinical outcomes prediction.