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).
Highlights
Triage is a central task in an emergency department (ED)
Little or no evidence can be found on the association between specific vital signs or reasons for the ED visit and mortality in the group of general patients presenting in EDs
The study aimed to assess whether the Rapid Acute Physiology Score (RAPS) could be used to predict mortality in nonsurgical patients on ED arrival
Summary
Triage is a central task in an emergency department (ED). In this context, triage is viewed as the rating of patients’ clinical urgency [1]. Rating is necessary to identify the order in which patients should be given care in an ED when demand is high. Triage is not needed if correct decision. Triage decisions may be based on both the patients’ vital signs (respiratory rate, oxygen saturation in blood, heart rate, blood pressure, level of consciousness, and body temperature) and their chief complaints. No consensus has been reached on the functions that should be measured. Apart from emergency care, triage may be used in other clinical activities, e.g. deciding on a certain investigation [4] or treatment [5]
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