Mitchell Rob, Bue Ovia, Nou Gary, Taumomoa Jude, Vagoli Ware, Jack Steven, Banks Colin, O'Reilly Gerard, Bornstein Sarah, Ham Tracie, Cole Travis, Reynolds Teri, Körver Sarah, Cameron Peter
Emergency Physician, Emergency & Trauma Centre, Alfred Health, Melbourne, Australia PhD Candidate, Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
Emergency Physician, Emergency Department, Gerehu General Hospital, Port Moresby, Papua New Guinea.
Lancet Reg Health West Pac. 2021 Jul 22;13:100194. doi: 10.1016/j.lanwpc.2021.100194. eCollection 2021 Aug.
The Interagency Integrated Triage Tool (IITT) is a three-tier triage system designed for resource-limited emergency care (EC) settings. This study sought to assess the validity and reliability of a pilot version of the tool in an urban emergency department (ED) in Papua New Guinea.
A pragmatic observational study was conducted at Gerehu General Hospital in Port Moresby, commencing eight weeks after IITT implementation. All ED patients presenting within the subsequent two-month period were included. Triage assessments were performed by a variety of ED clinicians, including community health workers, nurses and doctors. The primary outcome was sensitivity for the detection of time-critical illness, defined by ten pre-specified diagnoses. The association between triage category and ED outcomes was examined using Cramer's V correlation coefficient. Reliability was assessed by inter-rater agreement between a local and an experienced, external triage officer.
Among 4512 presentations during the study period, 58 (1.3%) were classified as category one (emergency), 967 (21.6%) as category two (priority) and 3478 (77.1%) as category three (non-urgent). The tool's sensitivity for detecting the pre-specified set of time-sensitive conditions was 70.8% (95%CI 58.2-81.4%), with negative predictive values of 97.3% (95%CI 96.7 - 97.8%) for admission/transfer and 99.9% (95%CI 99.7 - 100.0%) for death. The admission/transfer rate was 44.8% (26/58) among emergency patients, 22.9% (223/976) among priority patients and 2.7% (94/3478) among non-urgent patients (Cramer's V=0.351, p=0.00). Four of 58 (6.9%) emergency patients, 19/976 (2.0%) priority patients and 3/3478 (0.1%) non-urgent patients died in the ED (Cramer's V=0.14, p=0.00). The under-triage rate was 2.7% (94/3477) and the over-triage rate 48.2% (28/58), both within pre-specified limits of acceptability. On average, it took staff 3 minutes 34 seconds (SD 1:06) to determine and document a triage category. Among 70 observed assessments, weighted was 0.84 (excellent agreement).
The pilot version of the IITT demonstrated acceptable performance characteristics, and validation in other EC settings is warranted.
This project was funded through a Friendship Grant from the Australian Government Department of Foreign Affairs and Trade and an International Development Fund Grant from the Australasian College for Emergency Medicine Foundation.
跨部门综合分诊工具（IITT）是一种为资源有限的急诊护理（EC）环境设计的三级分诊系统。本研究旨在评估该工具试点版本在巴布亚新几内亚一家城市急诊科（ED）中的有效性和可靠性。
在莫尔斯比港的格雷胡综合医院进行了一项实用的观察性研究，在IITT实施八周后开始。纳入随后两个月内就诊的所有ED患者。分诊评估由包括社区卫生工作者、护士和医生在内的各种ED临床医生进行。主要结果是检测时间紧迫疾病的敏感性，由十种预先指定的诊断定义。使用克莱姆V相关系数检查分诊类别与ED结果之间的关联。通过当地和经验丰富的外部分诊官员之间的评分者间一致性来评估可靠性。
在研究期间的4512次就诊中，58例（1.3%）被分类为一类（紧急），967例（21.6%）为二类（优先），3478例（77.1%）为三类（非紧急）。该工具检测预先指定的一组时间敏感情况的敏感性为70.8%（95%CI 58.2 - 81.4%），入院/转诊的阴性预测值为97.3%（95%CI 96.7 - 97.8%），死亡的阴性预测值为99.9%（95%CI 99.7 - 100.0%）。紧急患者的入院/转诊率为44.8%（26/58），优先患者为22.9%（223/976），非紧急患者为2.7%（94/3478）（克莱姆V = 0.351，p = 0.00）。58例紧急患者中有4例（6.9%）、976例优先患者中有19例（2.0%）、3478例非紧急患者中有3例（0.1%）在ED死亡（克莱姆V = 0.14，p = 0.00）。分诊不足率为2.7%（94/3477），分诊过度率为48.2%（28/58），均在预先指定的可接受范围内。工作人员平均需要3分34秒（标准差1:06）来确定并记录分诊类别。在70次观察评估中，加权κ为0.84（一致性极佳）。
IITT的试点版本表现出可接受的性能特征，有必要在其他EC环境中进行验证。
本项目由澳大利亚外交与贸易部的友谊赠款以及澳大拉西亚急诊医学学院基金会的国际发展基金赠款资助。
