Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan.
Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.
Emerg Med J. 2018 Jun;35(6):384-388. doi: 10.1136/emermed-2017-207214. Epub 2018 Mar 13.
The Japan Acuity and Triage Scale (JTAS) was developed based on Canadian Triage and Acuity Scale in 2012 and has been implemented in many Japanese EDs. We assessed the validity of JTAS by examining the association between JTAS triage levels and throughput and clinical outcomes in adult patients.
We conducted a retrospective analysis of prospectively collected clinical data in the ED of a Japanese tertiary-care hospital. We included self-presenting patients who were ≥16 years of age and triaged between June 2013 and May 2014. We assessed the association between the triage level and overall admission and admission to the intensive care units (ICUs) with multivariable logistic regression analysis adjusted with patients' age and the time of visit and ED length of stay using the Kruskal-Wallis rank-sum test. We examined the predictive ability of JTAS for determining overall and ICU admission using receiver operating characteristic curves.
We included a total of 27 120 adult patients in our study. The OR for overall admission was greater with a higher triage level compared with the lowest urgency levels. ED length of stay was significantly longer with a higher JTAS level (p<0.001). The OR for ICU admission was greater in JTAS 1 (117.93 (95% CI 69.07 to 201.38)) and JTAS 2 (9.43 (95% CI 13.74 to 29.30)) compared with the lowest urgency levels. The areas under the curve for the predictive ability of JTAS for overall and ICU admission were 0.726 and 0.792, respectively.
Our study suggests an association of JTAS acuity with overall admission, ICU admission and ED length of stay, thereby demonstrating the predictive validity of JTAS.
日本 acuity 和分诊量表（JTAS）于 2012 年在加拿大分诊和 acuity 量表基础上开发而成，已在许多日本 ED 中实施。我们通过检查 JTAS 分诊级别与成人患者吞吐量和临床结局之间的关联来评估 JTAS 的有效性。
我们对日本一家三级保健医院 ED 前瞻性收集的临床数据进行了回顾性分析。纳入自我呈现的年龄≥16 岁且 2013 年 6 月至 2014 年 5 月间分诊的患者。我们使用 Kruskal-Wallis 秩和检验，通过多变量逻辑回归分析调整患者年龄、就诊时间和 ED 住院时间，评估分诊级别与整体入院和入住重症监护病房（ICU）之间的关联。我们使用接收者操作特征曲线检查 JTAS 对确定整体和 ICU 入院的预测能力。
我们的研究共纳入 27120 名成年患者。与最低紧急程度相比，整体入院的 OR 随着分诊级别升高而增大。ED 住院时间随 JTAS 水平升高而显著延长（p<0.001）。与最低紧急程度相比，JTAS1（117.93（95%CI 69.07 至 201.38））和 JTAS2（9.43（95%CI 13.74 至 29.30））的 ICU 入院 OR 更高。JTAS 整体和 ICU 入院预测能力的曲线下面积分别为 0.726 和 0.792。
我们的研究表明 JTAS acuity 与整体入院、ICU 入院和 ED 住院时间相关，从而证明了 JTAS 的预测有效性。
