Emergency & Trauma Centre, Alfred Health, Melbourne, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.
Emergency Department, ANGAU Memorial Provincial Hospital, Lae, Papua New Guinea.
Australas Emerg Care. 2024 Mar;27(1):30-36. doi: 10.1016/j.auec.2023.07.005. Epub 2023 Aug 17.
The Interagency Integrated Triage Tool (IITT) is a three-tier triage instrument recommended by the World Health Organization, but only the pilot version of the tool has been comprehensively assessed for its validity and reliability. This study sought to evaluate the performance of the IITT in a resource-constrained emergency department (ED) during the COVID-19 pandemic.
This prospective observational study was conducted at ANGAU Memorial Provincial Hospital in Lae, Papua New Guinea. The study period commenced approximately six weeks after introduction of the IITT, coinciding with a major COVID-19 wave. The primary outcome was sensitivity for the detection of time-critical illness, defined by eight pre-specified conditions. Secondary outcomes included the relationship between triage category and disposition. Inter-rater reliability was assessed using Cohen's Kappa.
There were 759 eligible presentations during the study period. Thirty patients (4.0%) were diagnosed with one of the eight pre-specified time-critical conditions and 21 were categorised as red or yellow, equating to a sensitivity of 70.0% (95%CI 50.6-85.3). There was a clear association between triage category and disposition, with 22 of 53 red patients (41.5%), 72 of 260 yellow patients (27.7%) and 22 of 452 green patients (4.9%) admitted (p = <0.01). Negative predictive values for admission and death were 95.1% (95%CI 92.7-96.9) and 99.3% (95%CI 98.1-99.9) respectively. Among a sample of 106 patients, inter-rater reliability was excellent (κ = 0.83) and the median triage assessment time was 94 seconds [IQR 57-160].
In this single-centre study, the IITT's sensitivity for the detection of time-critical illness was comparable to previous evaluations of the tool and within the performance range reported for other triage instruments. There was a clear relationship between triage category and disposition, suggesting the tool can predict ED outcomes. Health service pressures related to COVID-19 may have influenced the findings.
Interagency Integrated Triage Tool（IITT）是世界卫生组织推荐的一个三级分诊工具，但该工具的试用版仅经过了有效性和可靠性的全面评估。本研究旨在评估在资源有限的急诊部门（ED）中 COVID-19 大流行期间使用 IITT 的性能。
这是一项在巴布亚新几内亚莱城的 ANGAU Memorial 省级医院进行的前瞻性观察研究。研究开始于大约引入 IITT 六周后，此时恰逢 COVID-19 大流行的一个主要浪潮。主要结局是检测到八种预先指定的危急病症的敏感性。次要结局包括分诊类别与处置之间的关系。使用 Cohen's Kappa 评估了组间可靠性。
研究期间共有 759 例符合条件的就诊。30 例（4.0%）患者被诊断出患有八种预先指定的危急病症之一，21 例被归类为红色或黄色，敏感性为 70.0%（95%CI 50.6-85.3）。分诊类别与处置之间存在明显关联，53 例红色患者中有 22 例（41.5%）、260 例黄色患者中有 72 例（27.7%）和 452 例绿色患者中有 22 例（4.9%）被收治入院（p<0.01）。入院和死亡的阴性预测值分别为 95.1%（95%CI 92.7-96.9）和 99.3%（95%CI 98.1-99.9）。在 106 例患者的样本中，组间可靠性为极好（κ=0.83），分诊评估中位时间为 94 秒[IQR 57-160]。
在这项单中心研究中，IITT 检测危急病症的敏感性与之前对该工具的评估相当，且在其他分诊工具报告的性能范围内。分诊类别与处置之间存在明显关系，表明该工具可以预测 ED 结局。与 COVID-19 相关的卫生服务压力可能影响了研究结果。
