Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
Department of Emergency Medicine, Ton-Yen General Hospital, Zhupei, Taiwan.
Emerg Med J. 2019 Aug;36(8):472-478. doi: 10.1136/emermed-2018-207509.
This study aimed to determine the inter-rater reliability of the five-level Taiwan Triage and Acuity Scale (TTAS) when used by emergency medical technicians (EMTs) and triage registered nurses (TRNs). Furthermore, it sought to validate the prehospital TTAS scores according to ED hospitalisation rates and medical resource consumption.
This was a prospective observational study. After training in five-level triage, EMTs triaged patients arriving to the ED and agreement with the nurse triage (TRN) was assessed. Subsequently, these trained research EMTs rode along on ambulance calls and assigned TTAS scores for each patient at the scene, while the on-duty EMTs applied their standard two-tier prehospital triage scale and followed standard practice, blinded to the TTAS scores. The accuracy of the TTAS scores in the field for prediction of hospitalisation and medical resource consumption were analysed using logistic regression and a linear model, respectively, and compared with the accuracy of the current two-tier prehospital triage scale.
After EMT's underwent initial training in five-level TTAS, inter-rater agreement between EMTs and TRNs for triage of ED patients was very good (κw=0.825, CI 0.750 to 0.900). For the outcome of hospitalisation, TTAS five-level system (Akaike's Information Criteria (AIC)=486, area under the curve (AUC)=0.75) showed better discrimination compared with TPTS two-level system (AIC=508, AUC=0.66). Triage assignments by the EMTs using the the five-level TTAS was linearly associated with hospitalisation and medical resource consumption.
A five-level prehospital triage scale shows good inter-rater reliability and superior discrimination compared with the two-level system for prediction of hospitalisation and medical resource requirements.
本研究旨在确定急诊医疗技术员（EMT）和分诊注册护士（TRN）使用台湾分诊和 acuity 量表（TTAS）五级时的评分者间信度。此外，还根据 ED 住院率和医疗资源消耗来验证院前 TTAS 评分。
这是一项前瞻性观察研究。在进行五级分诊培训后，EMT 对到达 ED 的患者进行分诊，并评估与护士分诊（TRN）的一致性。随后，这些经过培训的研究 EMT 随救护车出勤，并在现场为每位患者分配 TTAS 评分，而值班 EMT 使用标准的两级院前分诊量表，并根据标准操作流程进行分诊，对 TTAS 评分不知情。使用逻辑回归和线性模型分别分析 TTAS 评分在现场对住院和医疗资源消耗的预测准确性，并与现行的两级院前分诊量表的准确性进行比较。
EMT 接受五级 TTAS 初始培训后，EMT 和 TRN 对 ED 患者分诊的评分者间一致性非常好（κw=0.825，CI 0.750 至 0.900）。对于住院结局，TTAS 五级系统（Akaike 的信息准则（AIC）=486，曲线下面积（AUC）=0.75）比 TPTS 两级系统（AIC=508，AUC=0.66）具有更好的区分能力。EMT 使用五级 TTAS 进行的分诊分配与住院和医疗资源消耗呈线性相关。
与两级系统相比，五级院前分诊量表在预测住院和医疗资源需求方面具有良好的评分者间信度和更高的区分能力。
