Cargando…
Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study
BACKGROUND: The 5-level triage tool, the Korean Triage and Acuity Scale (KTAS), was developed based on the Canadian Triage and Acuity Scale and has been used for triage in all emergency medical institutions in Korea since 2016. This study evaluated the association between the decrease in level numbe...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Academy of Medical Sciences
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460112/ https://www.ncbi.nlm.nih.gov/pubmed/30977315 http://dx.doi.org/10.3346/jkms.2019.34.e114 |
_version_ | 1783410284738641920 |
---|---|
author | Ryu, Ji-Ho Min, Mun-Ki Lee, Dae-Sup Yeom, Seok-Ran Lee, Seong-Hwa Wang, Il-Jae Cho, Suck-Ju Hwang, Seong-Youn Lee, Jun-Ho Kim, Yong-Hwan |
author_facet | Ryu, Ji-Ho Min, Mun-Ki Lee, Dae-Sup Yeom, Seok-Ran Lee, Seong-Hwa Wang, Il-Jae Cho, Suck-Ju Hwang, Seong-Youn Lee, Jun-Ho Kim, Yong-Hwan |
author_sort | Ryu, Ji-Ho |
collection | PubMed |
description | BACKGROUND: The 5-level triage tool, the Korean Triage and Acuity Scale (KTAS), was developed based on the Canadian Triage and Acuity Scale and has been used for triage in all emergency medical institutions in Korea since 2016. This study evaluated the association between the decrease in level number and the change in its relative importance for disposition in the emergency department (ED). METHODS: Using the registry of the National Emergency Department Information System (NEDIS) ver. 3.1, data regarding consecutive emergency patients from March 2017 to October 2017 were reviewed retrospectively. Reconfiguring KTAS levels, a total of 15 multinomial logistic regression models (KTAS_0 to KTAS_14), including the KTAS, its variants, and covariates were constructed to determine significant factors affecting ED disposition. The relative importance of each model was obtained using a dominance analysis. RESULTS: A total of 79,771 patients were included in the analysis. In the model KTAS_0, the KTAS and 8 covariates were found to be significantly related to ED disposition. The KTAS and the decision maker of each ED visit, whether it was the physician or others, had the largest relative importance, 34.8% and 31.4%, respectively (P < 0.001). In other models of KTAS variants, including 4-level, 3-level and 2-level, the rates of the KTAS decreased to 31.8% (interquartile range [IQR], 28.9–34.2), 26.4% (IQR, 23.2–31.0), and 18.7% (IQR, 7.5–24.9), respectively (P = 0.016). On the other hand, the rates for covariates tended to be larger for smaller triage levels and so there was a significant interaction effect between the KTAS and the covariates according to the triage level (P < 0.001). CONCLUSION: The 5-level triage tool, the KTAS, had the largest relative importance among the predictors affecting ED disposition only at its original level. Therefore, it is recommended that no attempt should be made to reduce the number of levels in the triage tool. |
format | Online Article Text |
id | pubmed-6460112 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | The Korean Academy of Medical Sciences |
record_format | MEDLINE/PubMed |
spelling | pubmed-64601122019-04-16 Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study Ryu, Ji-Ho Min, Mun-Ki Lee, Dae-Sup Yeom, Seok-Ran Lee, Seong-Hwa Wang, Il-Jae Cho, Suck-Ju Hwang, Seong-Youn Lee, Jun-Ho Kim, Yong-Hwan J Korean Med Sci Original Article BACKGROUND: The 5-level triage tool, the Korean Triage and Acuity Scale (KTAS), was developed based on the Canadian Triage and Acuity Scale and has been used for triage in all emergency medical institutions in Korea since 2016. This study evaluated the association between the decrease in level number and the change in its relative importance for disposition in the emergency department (ED). METHODS: Using the registry of the National Emergency Department Information System (NEDIS) ver. 3.1, data regarding consecutive emergency patients from March 2017 to October 2017 were reviewed retrospectively. Reconfiguring KTAS levels, a total of 15 multinomial logistic regression models (KTAS_0 to KTAS_14), including the KTAS, its variants, and covariates were constructed to determine significant factors affecting ED disposition. The relative importance of each model was obtained using a dominance analysis. RESULTS: A total of 79,771 patients were included in the analysis. In the model KTAS_0, the KTAS and 8 covariates were found to be significantly related to ED disposition. The KTAS and the decision maker of each ED visit, whether it was the physician or others, had the largest relative importance, 34.8% and 31.4%, respectively (P < 0.001). In other models of KTAS variants, including 4-level, 3-level and 2-level, the rates of the KTAS decreased to 31.8% (interquartile range [IQR], 28.9–34.2), 26.4% (IQR, 23.2–31.0), and 18.7% (IQR, 7.5–24.9), respectively (P = 0.016). On the other hand, the rates for covariates tended to be larger for smaller triage levels and so there was a significant interaction effect between the KTAS and the covariates according to the triage level (P < 0.001). CONCLUSION: The 5-level triage tool, the KTAS, had the largest relative importance among the predictors affecting ED disposition only at its original level. Therefore, it is recommended that no attempt should be made to reduce the number of levels in the triage tool. The Korean Academy of Medical Sciences 2019-04-03 /pmc/articles/PMC6460112/ /pubmed/30977315 http://dx.doi.org/10.3346/jkms.2019.34.e114 Text en © 2019 The Korean Academy of Medical Sciences. https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Ryu, Ji-Ho Min, Mun-Ki Lee, Dae-Sup Yeom, Seok-Ran Lee, Seong-Hwa Wang, Il-Jae Cho, Suck-Ju Hwang, Seong-Youn Lee, Jun-Ho Kim, Yong-Hwan Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study |
title | Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study |
title_full | Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study |
title_fullStr | Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study |
title_full_unstemmed | Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study |
title_short | Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study |
title_sort | changes in relative importance of the 5-level triage system, korean triage and acuity scale, for the disposition of emergency patients induced by forced reduction in its level number: a multi-center registry-based retrospective cohort study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460112/ https://www.ncbi.nlm.nih.gov/pubmed/30977315 http://dx.doi.org/10.3346/jkms.2019.34.e114 |
work_keys_str_mv | AT ryujiho changesinrelativeimportanceofthe5leveltriagesystemkoreantriageandacuityscaleforthedispositionofemergencypatientsinducedbyforcedreductioninitslevelnumberamulticenterregistrybasedretrospectivecohortstudy AT minmunki changesinrelativeimportanceofthe5leveltriagesystemkoreantriageandacuityscaleforthedispositionofemergencypatientsinducedbyforcedreductioninitslevelnumberamulticenterregistrybasedretrospectivecohortstudy AT leedaesup changesinrelativeimportanceofthe5leveltriagesystemkoreantriageandacuityscaleforthedispositionofemergencypatientsinducedbyforcedreductioninitslevelnumberamulticenterregistrybasedretrospectivecohortstudy AT yeomseokran changesinrelativeimportanceofthe5leveltriagesystemkoreantriageandacuityscaleforthedispositionofemergencypatientsinducedbyforcedreductioninitslevelnumberamulticenterregistrybasedretrospectivecohortstudy AT leeseonghwa changesinrelativeimportanceofthe5leveltriagesystemkoreantriageandacuityscaleforthedispositionofemergencypatientsinducedbyforcedreductioninitslevelnumberamulticenterregistrybasedretrospectivecohortstudy AT wangiljae changesinrelativeimportanceofthe5leveltriagesystemkoreantriageandacuityscaleforthedispositionofemergencypatientsinducedbyforcedreductioninitslevelnumberamulticenterregistrybasedretrospectivecohortstudy AT chosuckju changesinrelativeimportanceofthe5leveltriagesystemkoreantriageandacuityscaleforthedispositionofemergencypatientsinducedbyforcedreductioninitslevelnumberamulticenterregistrybasedretrospectivecohortstudy AT hwangseongyoun changesinrelativeimportanceofthe5leveltriagesystemkoreantriageandacuityscaleforthedispositionofemergencypatientsinducedbyforcedreductioninitslevelnumberamulticenterregistrybasedretrospectivecohortstudy AT leejunho changesinrelativeimportanceofthe5leveltriagesystemkoreantriageandacuityscaleforthedispositionofemergencypatientsinducedbyforcedreductioninitslevelnumberamulticenterregistrybasedretrospectivecohortstudy AT kimyonghwan changesinrelativeimportanceofthe5leveltriagesystemkoreantriageandacuityscaleforthedispositionofemergencypatientsinducedbyforcedreductioninitslevelnumberamulticenterregistrybasedretrospectivecohortstudy |