Validity of the Crisis Triage Rating Scale among Attendees of a Psychiatric Emergency Department in Nigeria

Abstract

Background: In psychiatric emergencies, there is a high premium on rapid assessment and acuity categorization. The Crisis Triage Rating Scale (CTRS), a 3-item clinician-rated instrument, has been validated for assessing the severity or urgency of emotional crises in psychiatric emergency units. The CTRS also expedites the screening of patients who require hospital admission from those who are suitable for out-patient treatment. However, its utility has not been evaluated in Nigeria. Aim: This study aimed to assess the validity of the CTRS as a triage tool among patients attending a psychiatric emergency service in Nigeria. Method: The CTRS was administered to consecutively presenting patients (N=247) at the Emergency Unit of the Federal Neuro-Psychiatric Hospital, Yaba, Lagos, Nigeria. The ability of the CTRS to discriminate between various levels of urgency of crises and to predict the need for admission at different threshold scores, compared with clinical judgement as criterion, was determined statistically. Results: CTRS scores ranged from 3 to 15 with a mean score of 12.18 (±2.8). The optimal threshold on the CTRS for detecting emergency or urgent crises is a cut-off score of 10 as it has the best trade-off with a sensitivity of 0.93 and specificity of 0.87. At this threshold, the area under the Receiver operating characteristics curve is 0.959 (95% CI= 0.934-0.983, p<0.001). The concurrent validity of the CTRS with the Clinical Global Impairment (CGI) was also satisfactory (r=-0.62, p<0.001). Conclusion: The CTRS is a useful tool in the triaging and disposal of patients presenting to psychiatric emergency service in Nigeria.