Rashid Khalifa, Ullah Maaz, Ahmed Syed T, Sajid Muhammad Z, Hayat Muhammad A, Nawaz Bakht, Abbas Kiran
Department of Emergency Medicine, Hayatabad Medical complex (HMC), Peshawar, PAK.
Department of Medicine, Ayub Teaching Hospital, Abbottabad, PAK.
Cureus. 2021 Dec 7;13(12):e20229. doi: 10.7759/cureus.20229. eCollection 2021 Dec.
Introduction Patient saturation in emergency care departments is a significant issue that impacts the healthcare system globally. This study was purposed to evaluate the accuracy of the ER triage using the Emergency Severity Index (ESI). Methodology A prospective observational study was performed at Hayatabad Medical Complex, Peshawar, from October 2020 to March 2021. Data from one of the second largest hospitals in Khyber Pakhtunkhwa were acquired to carry out this study. All data from our emergency department have been retrieved and recorded using appropriate procedures and software. Triage accuracy has been established by comparing proposed resource consumption (acuity level 3-5) to the actual resources utilized in these hospitals as the amount of an agreement between standard guidelines and local observations. In terms of resource expenditure, we also assessed the interconnection between acuity level and extent of accuracy. SPSS version 21 (IBM Inc., Armonk, New York) was used to document and analyze all of the data. Results The greatest odds of undertriage to moderate acuity were associated with age ≥65 years; OR 1.49, 95% CI (1.25-1.72) and OR 2.18 CI (1.22-3.73) for under-triage to low acuity designations. Severe hypoxia, severe bradycardia, and severe tachycardia were all strongly linked with the risk of under-triage of moderate-acuity levels OR 2.19 95% CI (1.49-3.13); OR 2.54 (1.53-4.01); and OR 2.17 (1.61-2.88), respectively. Essentially, there were also significant associations with under-triage to moderate acuity due to the lack of oxygen saturation measurement. Hypertension (≥200mmHg) was linked with increased odds of undertriage to moderate acuity with OR 1.29 95% CI (0.68-2.01). There were no anomalous vital signs associated with an increased likelihood of over-triage to high and moderate ESI acuity levels. Conclusion Our study indicated that increasing the age of patients was a significant factor associated with odds of under-triage. Furthermore, certain vital signs, including severe bradycardia, tachycardia, and severe hypoxia, were connected to the risk of under-triage of moderate acuity. Further, large-scale and multicenter studies should be conducted to assess other triage systems, which may provide a more accurate and reliable approach to evaluate the severity of patients' injuries by the hospital staff and physicians in the emergency room. They should be translated to local languages to assign treatment priorities in a structured and dependable manner.
引言
急诊科患者饱和是一个影响全球医疗系统的重大问题。本研究旨在评估使用急诊严重程度指数（ESI）进行急诊分诊的准确性。
方法
2020年10月至2021年3月在白沙瓦的哈亚塔巴德医疗中心进行了一项前瞻性观察研究。获取了开伯尔-普赫图赫瓦省第二大医院之一的数据来开展本研究。我们急诊科的所有数据均已通过适当程序和软件进行检索和记录。通过将建议的资源消耗（3 - 5级 acuity）与这些医院实际使用的资源进行比较来确定分诊准确性，作为标准指南与当地观察结果之间的一致程度。在资源支出方面，我们还评估了 acuity 水平与准确程度之间的相互关系。使用SPSS 21版（IBM公司，纽约州阿蒙克）记录和分析所有数据。
结果
年龄≥65岁与分诊为中度 acuity 的漏诊几率最高相关；分诊为低 acuity 时的比值比（OR）为1.49，95%置信区间（CI）为（1.25 - 1.72），以及OR 2.18，CI为（1.22 - 3.73）。严重缺氧、严重心动过缓和严重心动过速都与中度 acuity 漏诊风险密切相关，OR分别为2.19，95% CI为（1.49 - 3.13）；OR 2.54（1.53 - 4.01）；以及OR 2.17（1.61 - 2.88）。实际上，由于缺乏血氧饱和度测量，也与分诊为中度 acuity 的漏诊存在显著关联。高血压（≥200mmHg）与分诊为中度 acuity 的漏诊几率增加相关，OR为1.29，95% CI为（0.68 - 2.01）。没有异常生命体征与分诊为高和中度ESI acuity 水平的过度分诊可能性增加相关。
结论
我们的研究表明，患者年龄增加是与漏诊几率相关的一个重要因素。此外，某些生命体征，包括严重心动过缓、心动过速和严重缺氧，与中度 acuity 漏诊风险相关。此外，应进行大规模多中心研究以评估其他分诊系统，这可能为急诊室的医院工作人员和医生提供一种更准确可靠的方法来评估患者损伤的严重程度。它们应被翻译成当地语言，以便以结构化和可靠的方式确定治疗优先级。
