Faculty of Nursing, The University of Sydney, Sydney, Australia.
Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia.
Emerg Med J. 2018 Aug;35(8):471-476. doi: 10.1136/emermed-2017-207227. Epub 2018 Jun 18.
This study aims to validate previously reported triage tool titled Sydney Triage to Admission Risk Tool (START+) and investigate whether an extended version of the tool could be used to identify and stream appropriate short stay admissions to ED observation units or specialised short stay inpatient wards.
This was a prospective study at two metropolitan EDs in Sydney, Australia. Consecutive triage encounters were observed by a trained researcher and START scores calculated. The primary outcome was length of stay <48 hours. Multivariable logistic regression was used to estimate area under curve of receiver operator characteristic (AUROC) for START scores. The original START tool was then extended to include frailty and multiple or major comorbidities as additional variables to assess for further predictive accuracy.
There were 894 patients analysed during the study period. Of the 894 patients, there were 732 patients who were either discharged from ED or admitted for <2 days. The AUROC for the original START+ tool was 0.80 (95% CI 0.77 to 0.83). The presence of frailty was found to add a further five points and multiple comorbidities added another four points on top of the START score, and the AUROC for the extended START score 0.84 (95% CI 0.81 to 0.88).
The overall performance of the extended ED disposition prediction tool that included frailty and multiple medical comorbidities significantly improved the ability of the START tool to identify patients likely to be discharged from ED or require short stay admission <2 days.
ACTRN12618000426280.
本研究旨在验证先前报道的分诊工具悉尼分诊入院风险工具（START+），并探讨该工具的扩展版本是否可用于识别和分流适当的短期住院患者到急诊科观察单元或专门的短期住院病房。
这是澳大利亚悉尼两家大都市急诊科的前瞻性研究。经过培训的研究人员对连续的分诊情况进行观察，并计算 START 评分。主要结局是住院时间<48 小时。采用多变量逻辑回归估计接收器操作特征曲线（ROC）的曲线下面积（AUROC）以评估 START 评分的预测准确性。然后，将原始 START 工具扩展到包括虚弱和多种或主要合并症作为额外变量，以评估进一步的预测准确性。
研究期间共分析了 894 例患者。在 894 例患者中，有 732 例患者从急诊科出院或住院<2 天。原始 START+工具的 AUROC 为 0.80（95%CI 0.77 至 0.83）。发现虚弱状态额外增加了五分，多种合并症在 START 评分的基础上又增加了四分，扩展的 START 评分的 AUROC 为 0.84（95%CI 0.81 至 0.88）。
纳入虚弱和多种合并症的扩展 ED 处置预测工具的整体性能显著提高了 START 工具识别可能从急诊科出院或需要<2 天短期住院的患者的能力。
ACTRN12618000426280。
