Koca Ayça, Polat Onur, Oğuz Ahmet Burak, Genç Sinan, Günalp Müge, Değirmenci Soner, Tekin Deniz, Çullas Ilarslan Nisa Eda, Göktüğ Aytaç, Karakiliç Muhammed Evvah, Tanriöver Ömer Özgür, Demir Salih, Sevindik Mesut
Department of Emergency Medicine, School of Medicine, Ankara University, Ankara, Turkey.
Department of Emergency Medicine, Kars State Hospital, Kars, Turkey.
Disaster Med Public Health Prep. 2022 Jun 29;17:e162. doi: 10.1017/dmp.2022.101.
Triage is a tool used to determine patients' severity of illness or injury within minutes of arrival. This study aims to assess the reliability and validity of a new computer-based triage decision support tool, ANKUTRIAGE, prospectively.
ANKUTRIAGE, a 5-level triage tool was established considering 2 major factors, patient's vital signs and characteristics of the admission complaint. Adult patients admitted to the ED between July and October, 2019 were consecutively and independently double triaged by 2 assessors using ANKUTRIAGE system. To measure inter-rater reliability, quadratic-weighted kappa coefficients (Kw) were calculated. For the validity, associations among urgency levels, resource use, and clinical outcomes were evaluated.
The inter-rater reliability between users of ANKUTRIAGE was excellent with an agreement coefficient (Kw) greater than 0.8 in all compared groups. In the validity phase, hospitalization rate, intensive care unit admission and mortality rate decreased from level 1 to 5. Likewise, according to the urgency levels, resource use decreased significantly as the triage level decreased ( < 0.05).
ANKUTRIAGE proved to be a valid and reliable tool in the emergency department. The results showed that displaying the key discriminator for each complaint to assist decision leads to a high inter-rater agreement with good correlation between urgency levels and clinical outcomes, as well as between urgency levels and resource consumptions.
分诊是一种用于在患者到达后几分钟内确定其疾病或损伤严重程度的工具。本研究旨在前瞻性地评估一种新的基于计算机的分诊决策支持工具ANKUTRIAGE的可靠性和有效性。
ANKUTRIAGE是一种五级分诊工具，它考虑了两个主要因素，即患者的生命体征和入院主诉特征。2019年7月至10月期间入住急诊科的成年患者由两名评估人员使用ANKUTRIAGE系统进行连续且独立的双重分诊。为了测量评分者间的可靠性，计算了二次加权kappa系数（Kw）。为了评估有效性，对紧急程度、资源使用和临床结果之间的关联进行了评估。
ANKUTRIAGE使用者之间的评分者间可靠性极佳，在所有比较组中一致性系数（Kw）均大于0.8。在有效性阶段，住院率、重症监护病房入住率和死亡率从1级到5级逐渐降低。同样，根据紧急程度，随着分诊级别降低，资源使用显著减少（<0.05）。
ANKUTRIAGE在急诊科被证明是一种有效且可靠的工具。结果表明，展示每个主诉的关键鉴别因素以辅助决策可导致评分者间高度一致，紧急程度与临床结果以及紧急程度与资源消耗之间具有良好的相关性。
