CINTESIS - Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.
MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
J Med Syst. 2023 Jan 30;47(1):16. doi: 10.1007/s10916-023-01913-8.
With the increasing influx of patients and frequent overcrowding, the adoption of a valid triage system, capable of distinguishing patients who need urgent care, from those who can wait safely is paramount. Hence, the aim of this study is to evaluate the validity of the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) in a Portuguese tertiary hospital. Furthermore, we aim to study the performance and appropriateness of the different surrogate severity markers to validate triage. This is a retrospective study considering all visits to the hospital's Paediatric Emergency Department (PED) between 2014 and 2019. This study considers cut-offs on all triage levels for dichotomization in order to calculate validity measures e.g. sensitivity, specificity and likelihood ratios, ROC curves; using hospital admission, admission to intensive care and the use of resources as outcomes/markers of severity. Over the study period there were 0.2% visits triaged as Level 1, 5.7% as Level 2, 39.4% as Level 3, 50.5% as Level 4, 4.2% as Level 5, from a total of 452,815 PED visits. The area under ROC curve was 0.96, 0.71, 0.76, 0.78, 0.59 for the surrogate markers: "Admitted to intensive care"; "Admitted to intermediate care"; "Admitted to hospital"; "Investigations performed in the PED" and "Uses PED resources", respectively. The association found between triage levels and the surrogate markers of severity suggests that the PedCTAS is highly valid. Different surrogate outcome markers convey different degrees of severity, hence different degrees of urgency. Therefore, the cut-offs to calculate validation measures and the thresholds of such measures should be chosen accordingly.
随着患者人数的不断增加和频繁的过度拥挤，采用有效的分诊系统，能够区分需要紧急护理的患者和可以安全等待的患者至关重要。因此，本研究旨在评估小儿加拿大分诊和 acuity 量表（PaedCTAS）在葡萄牙一家三级医院的有效性。此外，我们旨在研究不同替代严重程度标记物的性能和适当性，以验证分诊。这是一项回顾性研究，考虑了 2014 年至 2019 年期间医院儿科急诊部（PED）的所有就诊情况。本研究考虑了所有分诊水平的截止值进行二分法，以计算有效性衡量标准，如敏感性、特异性和似然比，ROC 曲线；使用住院、入住重症监护病房和使用资源作为严重程度的结果/标志物。在研究期间，有 0.2%的就诊者被分诊为 1 级，5.7%的就诊者被分诊为 2 级，39.4%的就诊者被分诊为 3 级，50.5%的就诊者被分诊为 4 级，4.2%的就诊者被分诊为 5 级，总共有 452815 例 PED 就诊。ROC 曲线下面积分别为 0.96、0.71、0.76、0.78、0.59，替代标志物为：“入住重症监护病房”；“入住中级护理病房”；“住院”；“在 PED 进行的检查”和“使用 PED 资源”。分诊水平与严重程度替代标志物之间的关联表明，PedCTAS 具有高度的有效性。不同的替代结果标志物传达了不同程度的严重程度，因此也传达了不同程度的紧迫性。因此，应该相应地选择计算验证措施的截止值和这些措施的阈值。
