Triage assessment of transitory loss of consciousness in the emergency department—A retrospective observational study

Abstract

Aim: To establish how the Manchester Triage System can correctly prioritize patients admitted to the emergency department for transitory loss of consciousness in relation to their risk of presenting severe acute disease. Design: A observational retrospective study. Methods: A total of 2291 patients who required a triage evaluation for a transitory loss of consciousness at the emergency department of Merano Hospital between 1 January 2017 and 30 June 2019 were considered. Transitory loss of consciousness was classified according to European Society of Cardiology guidelines. The baseline characteristics of the patients were collected and divided according to the priority level assigned at triage into two different study groups: high priority (red/orange) and low priority (blue/green/yellow). The composite outcome of the study was defined as the diagnosis of a severe acute disease. Results: Of the patients enrolled, 17% (390/2291) had a high-priority code and 83% (1901/2291) received a low-priority code. Overall, a severe acute disease was present in 16.9% of patients (387/2291). The Manchester Triage System had a sensitivity of 42.4%, a specificity of 88.1% and an accuracy of 80.4% for predicting severe acute disease. The discriminatory ability had an area under the receiver operating characteristic curve of 0.651 (CI 95%: 0.618-0.685).Conclusions: Despite the good specificity, the low sensitivity does not currently allow the Manchester Triage System to completely exclude patients with a severe acute disease who presented in the emergency department for a transitory loss of consciousness. Therefore, it is important to develop precise nursing tools or assessments that can improve triage performance. Impact:The assessment of a complex symptom can create difficulties in the stratification of patients in triage, assigning low-priority codes to patients with a severe disease. Additional tools are needed to allow the correct triage assessment of patients presenting with transitory loss of consciousness.

Daily triage audit can improve nurses' triage stratification: A pre–post study

“…While the deficits in concordance may be partly due to an excessive attempt of the triage systems to aim at an exhausting search for standardization and simplification even of heterogeneous and complex clinical presentations, the need to combine this strictly objective methodology of the triage systems with the advantage of the clinical experience of the individual nurse and his learning pathway in clinical practice may also emerge. Therefore, the daily triage audit could be part of the latter, stimulating continuous professional growth and the attainment of experience based on the comparison that could refine the schematic nature of triage systems even in those complex presentations that are difficult to harness within specific diagrams or flow‐charts based on symptoms (Ausserhofer et al, 2020; Zaboli, Ausserhofer, Sibilio, Paulmichl, Toccolini, Pfeifer, et al, 2022).…”

The Effect of using Dimensionality Reduction Compared with Type of Algorithm on Detecting Patient Fall: Triage Case Study

“…The growing number of patients affects triage, forcing patients with varying conditions to wait for hours, potentially leading to a loss of consciousness [2]. Loss of consciousness is a common and serious indicator that requires high-priority triage [3,4]. When a patient loses consciousness, he or she becomes unbalanced, which result in falls.…”

“…Many solutions were proposed, one solution is to use AI techniques. Many medical studies have suggested the use of digital triage systems and their enhancement through the application of arti cial intelligence techniques [3,4,[11][12][13]. Nevertheless, the use of ML and DL is expected to gradually spread in healthcare to include all medical specialties [5,14].…”

Validity of the Manchester triage system in the prioritization of patients with transient global amnesia in the emergency department

“…Recently, different studies have focused on evaluating the performance of MTS on individual symptom presentations, reporting conflicting results about its ability. While some studies have demonstrated a good ability of MTS to correctly identify and stratify certain symptoms and specific pathologies (e.g., chest pain, headache, and dyspnea), for other symptoms it has revealed a lower ability to prioritize patients with time‐dependent pathologies (e.g., cardiac syncope and pulmonary embolism) 7,8,10–13 …”

“…While some studies have demonstrated a good ability of MTS to correctly identify and stratify certain symptoms and specific pathologies (e.g., chest pain, headache, and dyspnea), for other symptoms it has revealed a lower ability to prioritize patients with time-dependent pathologies (e.g., cardiac syncope and pulmonary embolism). 7,8,[10][11][12][13] Difficulties in promptly and accurately recognizing TGA in the ED setting during the triage process could lead to incorrect priority codes assigned to patients (overtriage), resulting in inappropriate use of resources. The study aims to analyze the performance of MTS in the assessment of patients with a diagnosis of TGA.…”