Comparing two triage systems in predicting in-hospital mortality at the emergency department Karolinska University Hospital Solna, Stockholm, Sweden (KS)

Abstract

Purpose of the study: To identify patients with greatest risk of death or deterioration at the Emergency Department (ED) it is important that a well validated and user independent assessment of patients can be made. The triage system ADAPT (Adaptive process triage) using vital parameters, cause of attendance and previous health status to determine the triage level is utilized at the KS since 2007. The scoring system REMS (rapid emergency medicine score) uses vital parameters and chronological age to predict in-hospital mortality. The purpose of this study was to compare how the two different scoring systems prognosticate the patients that die within 24 h of admittance to KS. Materials and methods: This is a retrospective cohort study. Data from the patients that died in the KS between January 1, 2007 and May 7, 2009 were collected retrospectively. The ADAPT triage level was collected from the ED medical records. REMS points were counted retrospectively by using demographic data from the medical records (blood pressure, respiratory rate, pulse rate, GCS score and peripheral oxygen saturation). Results: 263 patients were included, whereof 144 women. The median age was 80 years (27–100). The patients that were given higher ADAPT triage levels at admittance also got higher retrospectively calculated REMS points. Low ADAPT priority resulted in a lower REMS point. Conclusions: The results indicate that REMS is equivalent to ADAPT in prognosticating severely ill patients. Further studies with more and also surviving patients are needed to confirm the validity.