Osti Nicola, Maino Alberto, Moreschini Giulia, Marinconz Cristina, Susca Nicola, Contu Cristina, Racanelli Vito, Brugnolli Anna
Department of Medicine, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
Center for Medical Sciences (CISMed), University of Trento, Trento, Italy.
Emerg Med Int. 2025 May 16;2025:2807776. doi: 10.1155/emmi/2807776. eCollection 2025.
Pulmonary embolism (PE) is a clinical condition frequently encountered in the emergency department (ED), with a high and early mortality rate. ED triage determines the priority of further evaluation of care at the time of patient arrival. Very little is known about the specific role of ED triage in PE. We aimed to evaluate (1) whether the current five-level triage (5LT) system can identify patients with PE and differently prioritize them for medical evaluation and (2) the discriminatory capacity of simplified revised Geneva score (SRGS) toward PE diagnosis when calculated by triage nurses. A retrospective chart review on ED patients who underwent computed tomography pulmonary angiography (CTPA) in 2023. Based on the CTPA report, patients were categorized into two subgroups: CTPA PE-negative and CTPA PE-positive. We then searched for correlations between PE diagnosis and triage priority level, time from triage to medical evaluation, SRGS, and National Early Warning Score 2 (NEWS2). Of the 196 patients included in the analysis (age 71.1 ± 16.9), 45 (23.0%) were CTPA PE-positive (26 proximal PE and 19 distal PE). There was no correlation between the assigned triage color code and the CTPA results. Although we found a statistically significant difference in the prevalence of CTPA-confirmed PE according to the results of the SRGS ( = 0.014), the SRGS calculated at the time of triage showed a poor prediction accuracy for subsequent PE diagnosis (area under curve [AUC] 0.608). NEWS2 was significantly associated with the triage-assigned priority level ( < 0.001). The current 5LT was unable to differently prioritize patients with or without PE, and it seems unlikely that implementation of SRGS in the triage nurse evaluation will significantly improve the prioritization of patients with suspected PE for medical evaluation. Nonetheless, application of SRGS in triage evaluation may improve the appropriateness of the subsequent clinical pathway for PE diagnosis and risk stratification.
肺栓塞（PE）是急诊科（ED）常见的临床病症，早期死亡率很高。急诊分诊在患者就诊时确定进一步评估护理的优先级。关于急诊分诊在PE中的具体作用知之甚少。我们旨在评估：（1）当前的五级分诊（5LT）系统能否识别出PE患者，并对他们进行不同优先级的医学评估；（2）分诊护士计算的简化修订版日内瓦评分（SRGS）对PE诊断的鉴别能力。对2023年在急诊科接受计算机断层扫描肺动脉造影（CTPA）的患者进行回顾性病历审查。根据CTPA报告，将患者分为两个亚组：CTPA PE阴性和CTPA PE阳性。然后，我们寻找PE诊断与分诊优先级水平、从分诊到医学评估的时间、SRGS和国家早期预警评分2（NEWS2）之间的相关性。纳入分析的196例患者（年龄71.1±16.9岁）中，45例（23.0%）为CTPA PE阳性（26例近端PE和19例远端PE）。分诊颜色代码与CTPA结果之间无相关性。尽管根据SRGS结果，我们发现CTPA确诊PE的患病率存在统计学显著差异（P = 0.014），但分诊时计算的SRGS对后续PE诊断的预测准确性较差（曲线下面积[AUC]为0.608）。NEWS2与分诊指定的优先级水平显著相关（P < 0.001）。当前的5LT无法对有或无PE的患者进行不同优先级的区分，并且在分诊护士评估中实施SRGS似乎不太可能显著改善疑似PE患者进行医学评估的优先级。尽管如此，在分诊评估中应用SRGS可能会提高后续PE诊断和风险分层临床路径的适宜性。
