Dong Sandy L, Bullard Michael J, Meurer David P, Blitz Sandra, Akhmetshin Edward, Ohinmaa Arto, Holroyd Brian R, Rowe Brian H
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Acad Emerg Med. 2007 Jan;14(1):16-21. doi: 10.1197/j.aem.2006.08.021.
Emergency department (ED) triage prioritizes patients on the basis of the urgency of need for care. eTRIAGE is a Web-based triage decision support tool that is based on the Canadian Triage and Acuity Scale (CTAS), a five level triage system (CTAS 1 = resuscitation, CTAS 5 = nonurgent).
To examine the validity of eTRIAGE on the basis of resource utilization and cost as measures of acuity.
Scores on the CTAS, specialist consultations, computed-tomography use, ED length of stay, ED disposition, and estimated ED and hospital costs (if the patient was subsequently admitted to hospital) were collected for each patient over a six month period. These data were queried from a database that captures all regional ED visits. Correlations between CTAS score and each outcome were measured by using logistic regression models (categorical variables), univariate analysis of variance (continuous variables), and the Kruskal-Wallis analysis of variance (costs). A multivariate regression model that used cost as the outcome was used to identify interaction between the variables presented.
Over the six month study, 29,524 patients were triaged by using eTRIAGE. When compared with CTAS level 3, the odds ratios for consultation, CT scan, and admission were significantly higher in CTAS 1 and 2 and were significantly lower in CTAS 4 and 5 (p < 0.001). When compared with CTAS levels 2-5 combined, the odds ratio for death in CTAS 1 was 664.18 (p < 0.001). The length of stay also demonstrated significant correlation with CTAS score (p < 0.001). Costs to the ED and hospital also correlated significantly with increasing acuity (median costs for CTAS levels in Canadian dollars: CTAS 1 = 2,690 dollars, CTAS 2 = 433 dollars, CTAS 3 = 288 dollars, CTAS 4 = 164 dollars, CTAS 5 = 139 dollars, and p < 0.001). Significant interactions between the data collected were found in a multivariate regression model, although CTAS score remained highly associated with costs.
Acuity measured by eTRIAGE demonstrates excellent predictive validity for resource utilization and ED and hospital costs. Future research should focus on specific presenting complaints and targeted resources to more accurately assess eTRIAGE validity.
急诊科分诊是根据患者所需护理的紧急程度对患者进行优先排序。电子分诊（eTRIAGE）是一种基于网络的分诊决策支持工具，它基于加拿大分诊与 acuity 量表（CTAS），这是一个五级分诊系统（CTAS 1 = 复苏，CTAS 5 = 非紧急）。
基于资源利用和成本作为 acuity 指标来检验电子分诊（eTRIAGE）的有效性。
在六个月的时间里，收集了每位患者的 CTAS 评分、专科会诊情况、计算机断层扫描使用情况、急诊科停留时间、急诊科处置情况以及估计的急诊科和医院成本（如果患者随后被收治入院）。这些数据是从一个记录所有区域急诊科就诊情况的数据库中查询得到的。通过使用逻辑回归模型（分类变量）、单因素方差分析（连续变量）以及 Kruskal-Wallis 方差分析（成本）来测量 CTAS 评分与每个结果之间的相关性。使用成本作为结果的多元回归模型来识别所呈现变量之间的相互作用。
在为期六个月的研究中，使用电子分诊（eTRIAGE）对 29524 名患者进行了分诊。与 CTAS 3 级相比，CTAS 1 级和 2 级患者会诊、CT 扫描和入院的优势比显著更高，而 CTAS 4 级和 5 级患者的优势比显著更低（p < 0.001）。与 CTAS 2 - 5 级合并相比，CTAS 1 级患者死亡的优势比为 664.18（p < 0.001）。停留时间也与 CTAS 评分显示出显著相关性（p < 0.001）。急诊科和医院的成本也与 acuity 增加显著相关（CTAS 各级别的中位数成本，以加元计：CTAS 1 = 2690 加元，CTAS 2 = 433 加元，CTAS 3 = 288 加元，CTAS 4 = 164 加元，CTAS 5 = 139 加元，且 p < 0.001）。在多元回归模型中发现了所收集数据之间的显著相互作用，尽管 CTAS 评分仍然与成本高度相关。
通过电子分诊（eTRIAGE）测量的 acuity 对资源利用以及急诊科和医院成本具有出色的预测有效性。未来的研究应关注特定的就诊主诉和针对性资源，以更准确地评估电子分诊（eTRIAGE）的有效性。
