Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
Emerg Med J. 2013 Jun;30(6):454-8. doi: 10.1136/emermed-2012-201423. Epub 2012 Jun 26.
An ideal triage system used in the emergency department (ED) should identify patients who need urgent medical care. The purpose of this study was to validate the Taiwan Triage and Acuity Scale (TTAS) for stratifying patients according to their severity, need for thrombolysis, resource utilisation, and outcome.
The authors retrospectively reviewed all admitted patients with a discharge diagnosis of acute ischaemic stroke from January 2010 to September 2011. Presenting complaints, activation of code stroke protocol, eligibility of intravenous tissue plasminogen activator treatment, time from ED arrival to treatment, and outcome at discharge were compared by the five-level triage system.
Of 706 enrolled patients (level 1, 55; level 2, 455; level 3, 192; level 4, 4; level 5, 0), there were 412 (58.4%) men and 294 women (41.6%), with a mean age of 69.4 years. The initial stroke severity, time from onset to arrival, time from arrival to imaging, proportion of patients for whom code stroke protocol was activated, length of hospital stay, and good functional outcome at discharge correlated with TTAS levels. A total of 84 patients were thrombolysis candidates, and 98.8% of them were designated as either level 1 or level 2. For those treated with thrombolytic therapy (n=47), the time from arrival to thrombolysis was not significantly different between TTAS level 1 and 2.
Acuity measured by the computerised TTAS demonstrated good validity in facilitating acute care of stroke patients with special regard to thrombolytic therapy.
理想的急诊科分诊系统应能够识别需要紧急医疗救治的患者。本研究旨在验证台湾分诊和急症分级系统（TTAS），以根据患者的严重程度、溶栓需求、资源利用和预后对患者进行分层。
作者回顾性分析了 2010 年 1 月至 2011 年 9 月期间所有因急性缺血性脑卒中入院的患者。通过五级分诊系统比较就诊时的主诉、启动卒中急救流程、静脉组织型纤溶酶原激活剂治疗的适应证、从急诊科到达至治疗的时间以及出院时的结局。
纳入的 706 例患者（1 级 55 例，2 级 455 例，3 级 192 例，4 级 4 例，5 级 0 例）中，男 412 例（58.4%），女 294 例（41.6%），平均年龄 69.4 岁。初始卒中严重程度、发病至到达的时间、到达至影像学检查的时间、启动卒中急救流程的患者比例、住院时间以及出院时的良好功能结局与 TTAS 分级相关。共有 84 例患者为溶栓候选者，其中 98.8%的患者被划分为 1 级或 2 级。对于接受溶栓治疗的患者（n=47），1 级和 2 级 TTAS 分级患者从到达至溶栓的时间无显著差异。
计算机化 TTAS 评估的严重程度在促进急性卒中患者的急救方面具有良好的有效性，特别是在溶栓治疗方面。
