Validation of the modified Japanese Triage and Acuity Scale-based triage system emphasizing the physiologic variables or mechanism of injuries

Abstract

BackgroundThe Canadian Triage and Acuity Scale is a valid triage system. The system was translated and implemented in the Japanese emergency departments (EDs) from 2012. This system was named the Japanese Triage and Acuity Scale; however, the validation studies of the Japanese Triage and Acuity Scale have been limited. In addition, for a patient with multiple complaints, it could become challenging, due to its requirement of a single complaint. Therefore, we hypothesized that a modified version of the Japanese Triage and Acuity Scale using first-order modifiers without chief complaint detection is accurate.MethodsA retrospective cohort study evaluated a correlation between the modified triage scale level and outcomes of all adult emergency department patients at a Japanese hospital.Construct validity of the modified triage scale level was assessed based on comparisons of total admission rate (including hospitalizations, emergency department deaths) and length of stay between triage levels.ResultsThe distributions of five levels of the triage scale (level 1 is the most urgent) among the 17,121 cases are as follows: 1:451, 2:1148, 3:7703, 4:7652, and 5:167. Total admission rates by each level were 1:89.8, 2:68.2, 3:26.4, 4:6.6, and 5:0.6 %, which progressively increased from level 5 to 1 and were significant (p < 0.01). Compared with patients in level 3, the odds of total admission rates were 14.4, 5.1, 0.27, and 0.030 for the patients in levels 1, 2, 4, and 5. The length of stay was longer in the patients with the more urgent levels except for those with level 1.ConclusionsThe modified version of the Japanese Triage and Acuity Scale is a valid predictor of total admission and length of stay and may enable the nurses to triage patients without detecting the chief complaints.

Admission Decisions Made by Emergency Physicians Can Reduce the Emergency Department Length of Stay for Medical Patients

“…Although we found no difference in the KTAS score of the admitted patients between the two periods, the KTAS and the CTAS are used as initial triage tools rather than prognostic tools in the ED [21]. However, some studies have reported that the score has a strong association with prognoses, such as mortality and ICU admission rates [29,30].…”

Unique characteristics of frequent presenters to the emergency department in a Japanese population: a retrospective analysis

“…Triage levels were based on the Japan Triage and Acuity Scale and classified as either severe, including resuscitation or emergent need for resuscitation, or non‐severe, including urgent, less urgent, and non‐urgent. This triage system has proven validity . The secondary outcomes were length of stay, method of arrival to the hospital, and discharge diagnosis.…”

Triage des patients à l’accueil d’une structure d’urgences. Présentation de l’échelle de tri élaborée par la Société française de médecine d’urgence : la FRench Emergency Nurses Classification in Hospital (FRENCH)

“…On peut citer un malaise, une douleur aiguë céphalique, thoracique, abdominale ou pelvienne, une hémorragie extériorisée non active, une lésion traumatologique avec déformation modérée ou impotence fonctionnelle totale… La prise en charge médico-infirmière conduit à la réalisation d'environ trois actes hospitaliers (exemple : perfusion d'antalgiques, prélèvement biologique, imagerie radiologique, suture cutanée complexe, réduction de luxation ou gypsothérapie) et souvent à une hospitalisation. Le niveau de tri 3 représente habituellement 30 [10,19] voire 40 % des patients [20,21]. Il constitue un groupe très hétérogène par la variabilité des motifs de recours aux soins et surtout par la présence éventuelle de comorbidités (exemple : maladie chronique, patient très âgé, femme enceinte) qui rendent les situations plus complexes et les durées de prise en charge plus longues.…”