Triage Scale Research Articles

The Suitability of the CdC field Triage for Korean Trauma Care

Purpose: Accurate and appropriate prehospital field triage is essential for a trauma system. The Korean trauma system (established in 2014) uses the trauma field triage algorithm of the United States Centers for Disease Control and Prevention (CDC). This study evaluated the suitability of the CDC field triage criteria for major trauma cases (injury severity score >15) in Korea. Methods: This retrospective cohort study evaluated trauma patients who presented at the authors’ regional trauma center from January 1 to May 7, 2017. The undertriage and overtriage rates of each CDC field triage step were calculated. Receiver operating characteristic curves were constructed, and the area under the curve (AUC) was evaluated for each step. Results: Among the 1,009 enrolled patients, 168 (16.7%) had major trauma. The undertriage/overtriage rates of each step (steps I, II, III, and IV) of CDC field triage were 9.2%/47.4%, 6.3%/50.8%, 4.5%/59.4%, and 5.3%/78.9%, respectively. The AUC values of each CDC triage step were 0.722, 0.783, 0.791, and 0.615, respectively. The AUC values of the separate components of each step (physiologic criteria, anatomic criteria, mechanism- of-injury criteria, and special considerations) were 0.722, 0.648, 0.647, and 0.456, respectively. Conclusions: The CDC field triage system is acceptable, but not ideal, for Korean trauma care. If we follow the protocol, it would be preferable to omit step IV. The Korean Triage and Acuity Scale may be a good indicator for in-hospital triage. However, a new triage protocol that is simple to estimate on-scene while having good performance should be developed.

PATHWAY FROM ADMISSION DEPARTMENT TO EMERGENCY DEPARTMENT OF MULTIDISCIPLINARY HOSPITAL

The article presents the overview of the admission department work organization in the Republic of Belarus and abroad. The main triage scales, which are applied in the emergency offices work all over the world, are presented. The domestic experience of up-to-date approaches to triage organization is examined using the example of Minsk City Clinical Hospital of Emergency Medical Care.

The Reliability and Accuracy of International Triage Scale in the Emergency Department (ED): A Literature Review

A large number of patient visits to the Emergency Department (ED) will influence the outcome of the services provided. The triage scale is one method designed to manage patient screening for quality service improvement. Several triage scales are employed internationally in the EDs including the Australasian Triage Scale (ATS), the Manchester Triage System (MTS), the Canadian Triage and Accuracy Scale (CTAS), and the Emergency Severity Index (ESI). Several studies have a concern to identify the reliability of the triage scale, but only a few of them identified the accuracy of the triage scale. The purpose of this literature review was to identify the best reliability and accuracy among ATS, MTS, CTAS, and ESI based on the literature. The literature search was conducted on electronic databases EBSCO and PubMed with keywords including (triage OR emergency department triage) AND reliability AND ((the Canadian Triage and Accuracy Scale OR CTAS) AND (the Australasian Triage Scale OR ATS) AND (the Manchester Triage System OR MTS) AND the Emergency Severity Index OR ESI)). Assessment of articles was composed based on the PRISMA format with criteria including primary research articles containing the reliability and accuracy of the triage scale in English and published between 2009 – 2019. A total of 271 publications were identified and only 10 studies were included in this literature review. The results reveal that ATS has a moderate level of reliability (k = 04 – 0.57) with an accuracy of 46.2% – 58.3%, CTAS has a good level reliability (k = 0.770) with accuracy of 49%, MTS have good to excellent level of reliability (k = 0.61 – 0.95) with accuracy of 49%, and ESI have moderate to excellent level reliability (k = 0.45 – 0.94) with accuracy of 59.6 % – 72.5%. Based on this review, MTS and ESI are the triage scale with the highest reliability and accuracy. Therefore, MTS and ESI are highly recommended in the ED. However, each EDs need to pay attention to the characteristics, culture, and available resources before choosing and implementing an appropriate triage scale.

Comparison between simple triage and rapid treatment and Taiwan Triage and Acuity Scale for the emergency department triage of victims following an earthquake-related mass casualty incident: a retrospective cohort study

BackgroundTriage plays a crucial role in the emergency department (ED) management of mass casualty incidents (MCIs) when resources are limited. This study aimed to compare the performance of simple triage and rapid treatment (START) with that of the Taiwan Triage and Acuity Scale (TTAS) for the ED triage of victims following an earthquake-related MCI.MethodsWe retrospectively reviewed the records of victims presenting at our ED with earthquake-related injuries within 24 h of a large-scale earthquake. TTAS was initially used at our ED for this event, and START was performed by retrospectively reviewing the patient records in a blinded manner. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START and TTAS were determined for predicting ED discharge.ResultsWe enrolled 105 patients (predominantly women, 60.0%; median age, 45.0 years) in this study; most of them presented with traumatic injuries and were initially triaged as TTAS level III (78.1%), followed by TTAS level II (11.4%). Although the majority of the victims (81.0%) were discharged, four deaths occurred. A moderate agreement in differentiating emergency from nonemergency patients was observed between START and TTAS. Furthermore, both the triage systems showed similar predictions for ED disposition (START AUC/sensitivity/specificity: 0.709/82.35%/55.00%; TTAS AUC/sensitivity/specificity: 0.709/90.59%/45.00%).ConclusionsThe present study demonstrated that START and TTAS have similar triage accuracy and ability to predict ED disposition. Our findings demonstrate that START may be used as an alternative to TTAS for the ED triage of victims following earthquake-related MCIs.

Using emergency physicians’ abilities to predict patient admission to decrease admission delay time

BackgroundIn many EDs, emergency physicians (EPs) do not have admitting privileges and must wait for consultants to further assess and admit patients. This delays bed requests and increases ED crowding....

Peripheral intravenous cannula insertion and use in a tertiary hospital emergency department: A cross-sectional study

IntroductionPeripheral intravenous cannula is often a first line invasive intervention for patients in the emergency department. It is used to facilitate blood sampling, deliver essential fluids, blood products and medication. However, the insertion and use of the peripheral intravenous cannula is not without complication. This study surveyed the number of peripheral intravenous cannulas inserted in the emergency department and identify the level of and reason for use. MethodsA cross-sectional study was conducted in the emergency department of a large tertiary hospital in Queensland. Descriptive and inferential statistics were used to describe peripheral intravenous cannula use and to explore associations. ResultsOf the 224 patients assessed, 159 (71%) had at least one peripheral intravenous cannula inserted in emergency department. Of the 159 peripheral intravenous cannulas inserted, 54 (34%) remained unused while the patient was in the emergency department. For patients classified as Australasian Triage Scale categories 3, 4 and 5, 40% of peripheral intravenous cannulas remained unused. Overall, poor documentation was observed with 29% of peripheral intravenous cannulas insertions not documented at all. ConclusionThis study identified a high proportion of unused peripheral intravenous cannulass in the emergency department and inadequate documentation. An intervention to promote best practice, raise awareness of the risks of peripheral intravenous cannulas use, possible alternatives therapies, and improve documentation is required.

Utilization of an Electronic Triage System by Emergency Department Nurses.

IntroductionEmergency departments use triage systems to prioritize patients according to the severity of their condition. The Electronic Canadian Triage and Acuity Scale (E-CTAS) is a popular system that categorizes patients into five levels to manage patient flow and prioritize patient access to health-care services.MethodsWe assessed the factors that influence E-CTAS usage in emergency departments in Eastern Saudi Arabia. Seventy-one nurses were included from two emergency departments that adopted E-CTAS. We used the technology acceptance model (TAM) to assess the influencing factors. The TAM was reliable in the study setting (Cronbach’s α = 0.87).ResultsAll of the TAM domains were significantly related to the usage of E-CTAS: perceived ease of use, perceived usefulness, importance of training, social influence, behavior intention, and attitude. We also showed that E-CTAS use significantly increased with years of experience and training.DiscussionMany factors influenced the use of this electronic triage system. Focusing on these factors in future electronic triage system implementations might increase the hospital staff’s compliance, thus improving accuracy and better organizing the patient flow in emergency departments.

日本緊急度判定支援システム（Japan Triage and Acuity Scale；JTAS）による判定の最適化

日本緊急度判定支援システム（Japan Triage and Acuity Scale；JTAS）による判定の最適化

Factors Associated with Family Physician Follow-up 30 Days Post-discharge from a Local Canadian Community Emergency Department.

IntroductionClose outpatient follow-up with a specialist or family physician post-discharge from the emergency department (ED) has been shown to increase adherence to antihypertensive medications, decrease mortality in heart failure, and reduce the odds of myocardial infarction or death after ED presentation for chest pain. A Canadian study demonstrated that 21% of patients who left the ED with a new diagnosis of atrial fibrillation, heart failure, or hypertension were not seen by a physician within 30 days. There is a paucity of research investigating why this follow-up does not occur. This study aimed to elucidate factors that are associated with outpatient follow-up by a family physician clinic following discharge from a local Canadian community emergency department.MethodsA retrospective chart review of patients rostered to a family physician who presented to the community ED in the past two years was conducted. The primary outcome examined was a documented follow-up visit with any physician at the clinic within 30 days of the index ED visit. Patients aged 18 or older at the time of the initial ED visit were eligible for inclusion in the study. Exclusion criteria were the following: patients aged 17 or younger at the time of the initial ED visit, those who were not fully assessed at ED visit (i.e., left against medical advice), those whose charts corresponding to the ED visit were unable to be found, patients who were admitted to any facility within 30 days of ED visit, and patients who died within 30 days of the ED visit. Variables of interest extracted from the ED chart and clinic electronic medical record were the following: Canadian Triage and Acuity Scale (CTAS) score, documented discharge instructions, age, sex, primary residence distance from the clinic, last documented clinic visit before ED visit, and the date of and presenting complaint of the next clinic visit after the ED visit. Data were collected as continuous and categorical variables. Descriptive statistics were used to show the number and percentages of patients who followed up in clinic. Binomial regression analysis was used to determine if a specific variable was associated with patient follow-up. Inter-rater reliability between data abstractors was calculated using Fleiss Κ. An alpha-value of 0.05 was chosen, and SPSS version 25.0 (IBM Corp., Armonk, NY) was used for all statistical analyses.ResultsA total of 234 patients out of 1292 patients met inclusion criteria. 53% of patients were female, and the mean age was 50. Seventy-two (31%) received discharge instructions from the ED physician to follow up with their family doctor. In total, 93 of the 234 patients proceeded to have a documented clinic visit within 30 days (40%). 52% (n = 48) of these were women. Receiving specific discharge instructions increased the adjusted odds of follow-up (OR 3.07, 95% CI: 1.64-5.76; P < 0.05). Patients who followed up also tended to have been seen in clinic in the last three months, but this was not statistically significant.ConclusionReceiving specific discharge instructions to follow-up increased the odds that patients followed up with their family physician after discharge from the ED. ED physicians may consider giving explicit instructions to patients to improve monitoring of ongoing clinical issues. More research needs to be conducted on how to improve transitions of care. Countries with different healthcare models may have other barriers to appropriate follow-up.

Abstract 33: Diagnostic Accuracy, Reperfusion Delay and Triage Scale Comparison: Real-World Paramedic Validation Results From the ACT-FAST Triage Algorithm for Thrombectomy

Background: Severity-based selection tools for large vessel occlusion (LVO) are limited by lack of validation in unselected prehospital stroke patients and concerns regarding delayed thrombolysis (tPA) and comprehensive stroke center (CSC) burdening. We examined these issues in a real-world validation of the two exam step (severe arm motor + speech or neglect) ACT-FAST LVO triage algorithm. Methods: The ACT-FAST statewide validation involved 15 metro and 17 rural hospitals in Victoria, Australia from Nov 2017-July 2019 with training of paramedics using an 8 min video. Prehospital paramedic assessments were correlated with hospital imaging to determine presence of LVO. Data were then examined for diagnostic accuracy, time saving for direct bypass to CSC using a validated Google maps model, rates and magnitude of delayed tPA in false-positive non-LVO infarcts, and extra CSC workload. Results: In 517 completed assessments, 58% involving non-EVT centers and including 114 (22%) LVO, ACT-FAST sensitivity was 81% (92/114) and specificity was 81% (325/403; 89% if ICH are not regarded as false-positive) for LVO. Figure compares to other LVO scales. Bypass to CSC was modelled to save median 71 min for analysis of 29 thrombectomy patients requiring inter-hospital transfer. Of 27 non-LVO infarcts with false positive ACT-FAST, only 4 (15%) received tPA at a non-CSC center, and bypass would have only added median 10 mins in these cases. The increase in CSC presentation using ACT-FAST triage was estimated to be 2-3.3 patients/week using estimated 7,200 suspected stroke cases/year across entire metro Victoria. Conclusion: In comprehensive real-world validation, the simple ACT-FAST algorithm detected LVO or ICH in almost 80% of positive assessments with highly favorable comparison to other scales. Prehospital bypass to CSC substantially reduces thrombectomy delay, and appears to strongly outweigh negatives of bypassing false positive cases on tPA delay and CSC overburdening.

Impact of an Electronic Decision-Support System on Nursing Triage Process: A Usability and Workflow Analysis.

To qualitatively contrast emergency department triage workflow using a paper-based triage system and an electronic decision-support tool (electronic Canadian Triage and Acuity Scale (eCTAS)). Triage nurses from a single institution were invited to perform triage assessments of mock patients using a paper-based triage system and eCTAS. These assessments were completed using simulation scenarios, some of which involved facilitators probing triage nurses' thoughts on the design of the eCTAS system. Participants were asked to "think aloud," describing their thought patterns as they completed the triage process. Similar patient scenarios with the same Canadian Emergency Department Information System (CEDIS) presenting complaint and triage score were used for comparison between paper-based triage and electronic decision-support tool (eCTAS) conditions. Eight participants completed at least two simulation scenarios for each condition and at least one usability scenario with eCTAS. The simulated encounters showed eCTAS provided several advantages to paper-based triage assessment process by shortlisting possible CEDIS complaints and preselecting relevant modifiers. However, usability concerns were identified with eCTAS including challenges related to data entry and eCTAS score overrides. Our study highlights several positive features of eCTAS and usability issues that should be addressed to enhance the intended use of eCTAS and support user adoption.

Machine Learning and Initial Nursing Assessment-Based Triage System for Emergency Department.

ObjectivesThe aim of this study was to develop machine learning (ML) and initial nursing assessment (INA)-based emergency department (ED) triage to predict adverse clinical outcome.MethodsThe retrospective study included ED visits between January 2016 and December 2017 that resulted in either intensive care unit admission or emergency room death. We trained four classifiers using logistic regression and a deep learning model on INA and low dimensional (LD) INA, logistic regression on the Korea Triage and acuity scale (KTAS) and Sequential Related Organ Failure Assessment (SOFA). We varied the outcome ratio for external validation. Finally, variables of importance were identified using the random forest model's information gain. The four most influential variables were used for LD modeling for efficiency.ResultsA total of 86,304 patient visits were included, with an overall outcome rate of 3.5%. The area under the curve (AUC) values for the KTAS model were 76.8 (74.9–78.6) with logistic regression and 74.0 (72.1–75.9) for the SOFA model, while the AUC values of the INA model were 87.2 (85.9–88.6) and 87.6 (86.3–88.9) with logistic regression and deep learning, suggesting that the ML and INA-based triage system result more accurately predicted the outcomes. The AUC values for the LD model were 81.2 (79.4–82.9) and 80.7 (78.9–82.5) for logistic regression and deep learning, respectively.ConclusionsWe developed an ML and INA-based triage system for EDs. The novel system was able to predict clinical outcomes more accurately than existing triage systems, KTAS and SOFA.

Educational Effect of Japan Triage and Acuity Scale Course under Pandemic of Covid-19 using Paper Participant Survey developed for Off-the-job-trainings

Educational Effect of Japan Triage and Acuity Scale Course under Pandemic of Covid-19 using Paper Participant Survey developed for Off-the-job-trainings

Validation of chief complaints, medical history, medications, and physician diagnoses structured with an integrated emergency department information system in Japan: the Next Stage ER system

AimEmergency department information systems (EDIS) facilitate free‐text data use for clinical research; however, no study has validated whether the Next Stage ER system (NSER), an EDIS used in Japan, accurately translates electronic medical records (EMRs) into structured data.MethodsThis is a retrospective cohort study using data from the emergency department (ED) of a tertiary care hospital from 2018 to 2019. We used EMRs of 500 random samples from 27,000 ED visits during the study period. Through the NSER system, chief complaints were translated into 231 chief complaint categories based on the Japan Triage and Acuity Scale. Medical history and physician’s diagnoses were encoded using the International Classification of Diseases, 10th Revision; medications were encoded as Anatomical Therapeutic Chemical Classification System codes. Two reviewers independently reviewed 20 items (e.g., presence of fever) for each study component (e.g., chief complaints). We calculated association measures of the structured data by the NSER system, using the chart review results as the gold standard.ResultsSensitivities were very high (>90%) in 17 chief complaints. Positive predictive values were high for 14 chief complaints (≥80%). Negative predictive values were ≥96% for all chief complaints. For medical history and medications, most of the association measures were very high (>90%). For physicians’ ED diagnoses, sensitivities were very high (>93%) in 16 diagnoses; specificities and negative predictive values were very high (>97%).ConclusionsChief complaints, medical history, medications, and physician’s ED diagnoses in EMRs were well‐translated into existing categories or coding by the NSER system.

The Impact of Emergency Department Overcrowding with Non-Urgent Visits on Mortality at King Khalid National Guard Hospital in Jeddah

Background: Emergency department (ED) overcrowding with non-urgent cases is a significant public health problem with several consequences, such as prolonged waiting time and delayed care for more acutely ill patients. Triage systems are established to determine the urgency of patients in the EDs. An example is the Canadian Triage and Acuity Scale (CTAS) which is a 5-category scale. Patients who are classified as CTAS 1, 2, and 3 are urgent, while CTAS 4 and 5 are non-urgent. Previous studies in Saudi Arabia show that 50-60% of ED visits are non-urgent, but did not investigate their association with mortality. Therefore, we aimed to determine the relationship between non-urgent ED visits and patients' mortality. Methods: A cross-sectional retrospective study was conducted at King Khalid National Guard Hospital in Jeddah. A convenient sample was retrieved from the BestCare database by including all ED visits which were categorized in CTAS from June 2016 to December 2018. Our variables were the CTAS category, gender, and age for each visit. Additionally, we obtained the total number of mortalities in the ED, during inpatient care, and overall mortality for each month. Data analysis was done using JMP software. After assessing the normality, the Spearman correlation test was used to evaluate the relationship between the ratio of non-urgent visits for each month and mortality during that month. Furthermore, we identified the most crowded periods of the ED within a year after we combined the same month from 2017 and 2018, so we had twelve pooled months. Results: A total of 127888 ED visits were enrolled in the study after the exclusion of 30407 visits, which were unspecified in CTAS. We found that 81% of the ED visits were non-urgent. Around 53% of the non-urgent patients were female, and the majority of them were adult patients aged between 18 and 44 years. The most crowded periods of ED visits were in the last three months of the year from October to December. There was no correlation between non-urgent visits and overall mortality, Spearman's coefficient (ρ) = 0.014, P = 0.938. Conclusion: There is no association between non-urgent visits and mortalities. The generalizability of the results is limited because the study was conducted in a single-center, and further studies are needed.

The causes of visits of non-urgent patients to an emergency department in King Fahad Hospital-Albaha-Kingdom of Saudi Arabia

OBJECTIVE: The use of the emergency department by patients presenting with non-urgent conditions has become an important problem that is faced by all local and global health systems. The main objective of this article is to determine the causes of non-urgent emergency department visits by patients. METHOD This is a retrospective, descriptive study, conducted in the emergency department from January to April 2020. All patients triaged according to the Canadian Triage and Acuity Scale (CTAS) as CTAS -5 (non-urgent conditions) were included during the study period and their data such as demographics and presenting complaints were extracted from the hospital electronic files. Ethical approval was taken from the hospital's ethical review board. RESULTS Out of 1308 patients that visited the emergency department (ED), 327 (25%) patients were categorized as non-urgent visits (CTAS-5) according to the triage system. There was a slight female predominance of 165(50.5%) as compared to males 162(49.5%). 71% of patients were between 20-40 years of age. It was identified that 92% of the selected patients had non-urgent conditions, did not need any treatment in ED, and could be treated and followed up in primary health clinics or hospital polyclinics. 32.7% of patients had no chronic illness and 32.1 % of the patients had visited the ED before at least one time for the same complaint. The most common complaints at presentation for non-urgent visits were musculoskeletal system pain (30.5%), mild non-surgical abdominal pain (17.7%), Upper respiratory tract infection (9.5%), and fever (3.7%). It was found that 5.8% needs to be upgraded to CTAS 3-4 zone for further assessment and management. CONCLUSION The majority of non-urgent visits at the emergency department could be treated in other facilities like primary health care and hospital polyclinics. Proper, safe application of triage system and necessary education to the patients can reduce the emergency department overcrowdedness which will ensure patients safety and improve patients' clinical outcome.

Characterising the number and type of presentations to a tertiary emergency department by young people affected by drugs and alcohol

Objective The aim of this study was to investigate the frequency and type of emergency department (ED) presentations involving drugs and/or alcohol (DA) among young people. Methods A retrospective chart review was conducted of patients aged 14-25 years who presented to the ED at a tertiary hospital between 7 October and 25 November 2013. Data were collected on standardised data sheets, including whether DA was a factor in the patient's presentation. Results In all, 713 ED presentations of patients aged 14-25 years were included in this review (mean age 20 years). Of these, 94 (13%) presentations involved DA (median blood alcohol level 0.12%; range 0.01-0.39%); among patients aged 14-17 years, 13 (8%) presentations involved DA. Patient presentations involving DA were more likely to occur overnight and at weekends, had higher Australasian Triage Scale scores and had longer ED lengths of stay. These patients were also more likely to present with aggression, because of an assault, or with mental health disorders. Conclusion DA are involved in a substantial number of presentations of young people to the ED and are associated with an increased risk of assault and aggression. Public health strategies should target the links between DA use and mental health in young people. What is known about the topic already? It is known that the use of alcohol and drugs in young people is an ongoing public health concern. Research suggests this cohort of the population is more likely to present to an ED with an injury than the comparative age group not intoxicated by drugs or alcohol, and is more likely to be reviewed after hours. Alcohol is the predominant drug that had been used by young people at the time of the present study. What does this paper add? This paper reviews the number and types of presentations to a tertiary ED. In so doing, many more areas were researched (rather than simply link to injury) and, as a result, it was found that young people present to the ED with an increased risk of mental health issues and an increased risk of aggression. The study also found that young people intoxicated with DA most commonly presented for different reasons than the same sober cohort. What are the implications for practitioners? We know that young people intoxicated with DA represent a different public health issue than the sample group, and, as a result, public health initiatives must concentrate on the confounding factors of the presenting complaint, notably education surrounding the risk of mental health disturbance and increased aggression rates. Furthermore, the study should benefit practitioners, showing that more mental health services should be available after hours for this cohort presenting with issues related to DA.

Characteristics Associated with Emergency Department Suitability in Low-Acuity Ambulance Cases

Objective To identify the patient and case characteristics associated with emergency department (ED) suitability of cases referred for emergency ambulance dispatch following ambulance-based secondary telephone triage. Methods A retrospective cohort analysis was conducted of secondary telephone triage cases transported to an ED by emergency ambulance between September 2009 and June 2012 in Melbourne, Australia. Patients were considered ED suitable if they were triaged as a category 1, 2 or 3 according to the Australian Triage Scale, were admitted to hospital or referred to another hospital for admission, or died in the ED. Descriptive statistics and multivariable binary logistic regression analysis were used to identify the variables associated with ED suitability. Results There were 2694 (21.2%) cases classified as ‘not ED suitable’. The mean age of this group was 51.7 years (SD 23.7 years) and 56.5% were female. Those that were ED suitable were older, with a mean age of 59.1 years (SD 22.6 years) and 53.6% were female. After adjusting for confounders the age (p&lt;0.001), pain (p&lt;0.001) and triage guideline groups (p&lt;0.001) variables had statistically significant relationships with ED suitability. Gender (p=0.108), time of day (p=0.118), secondary triage call-taker qualification (p=0.237) and comorbidities (p=0.182) showed no association with ED suitability, and income status was approaching significance (95% CI 0.85–1.02, p=0.055). Conclusion There are patient and case characteristics associated with ED suitability that could be used to improve patient triage to better match patients with care pathways appropriate to their needs.

Prescribers aware: a cross-sectional study from New Zealand emergency departments on the substances used in intentional self-poisoning and their sources.

INTRODUCTION Intentional self-poisoning or self-harm through poisoning, is a common cause of presentations to emergency departments (EDs). National datasets do not allow identification of the substances most commonly used in hospital-treated intentional self-poisoning in New Zealand, nor do they capture sources of these substances. AIM To investigate the specific substances used in intentional self-poisoning and the sources from which they are obtained. METHODS In this cross-sectional study, information about the demographics and presentation particulars of intentional self-poisoning patients aged ≥16 years, presenting to three public EDs, as well as the substances they used in the self-poisoning event and the sources of these agents, were collected prospectively. RESULTS A total of 102 patients were recruited from the potentially eligible 1137 intentional self-poisoning patients presenting to the three EDs during the study period. Seventy per cent used their own prescription medications and 24% used medicines they purchased themselves. Paracetamol and ethanol were most commonly encountered substances. Patients presented a median of 1.9h after exposure (interquartile range 1.0-3.3h), 62% self-referred, 60% presented to the ED in the evening or at night and 66% were triaged into Australasian Triage Scale 3 (to be seen within 30min). Two-thirds were referred to emergency psychiatric services. DISCUSSION Collecting specific substance information, such as from this study, can assist in planning specific activities to prevent intentional self-poisoning. As most people used their prescribed medicines, the findings can inform and assist doctors in their prescribing practices when they manage patients at risk of self-poisoning.

Comparison between Australasian triage scale and emergency severity index

Background The aim of triage system is to ensure that the treatment of patients in the Emergency departments will be according to their clinical urgency. Also, it decreases waiting time and helps in proper direction of the patients to the most suitable area for better assessment and treatment. Aim of the Work The purpose of this study is to compare the efficiency of Australasian Triage Scale versus the Emergency Severity Index triage systems. Methods Full medical history of 167 Patients arrived at the ED from January till March 2016 were recorded, chief complain, examination, resources number also were recorded and triaged by both systems. Results Our results revealed that the most frequent age group was between 20 to 40 years old, while the least frequent age group was ≥80 years old. The frequency of male patients was higher than the female patients. ATS and ESI were agreed in urgency level 1. Urgency level 2 and 5 was higher in ESI system while, Urgency level 3 and 4 was higher in ATS. The majority of the patients were discharged, while only 2.4 percent were dead. There were insignificant differences between ATS system and final outcome regarding degree of urgency. While, there was significant over-triage in urgency level 2, while there was significant under-triage in urgency levels 3–5 in comparison to final outcome. Conclusion We found that both systems are applicable, but ESI showed some limitation. So we recommended using ATS since it was easier to use and did not show any limitation.