The Copenhagen Triage Algorithm is non-inferior to a traditional triage algorithm: A cluster-randomized study

Area of Science:

• Emergency Medicine
• Clinical Triage Systems
• Health Services Research

Background:

• Emergency departments (EDs) globally utilize triage systems with limited clinical judgment.
• The Copenhagen Triage Algorithm (CTA) is a simplified system incorporating clinical assessment.

Purpose of the Study:

• To compare the Copenhagen Triage Algorithm (CTA) against a local adaptation of the Adaptive Process Triage (ADAPT) system.
• To evaluate the non-inferiority of CTA regarding short-term mortality and its predictive performance for 30-day mortality.

Main Methods:

• A two-center, cluster-randomized crossover study involving 45,347 patient visits.
• CTA, based on vital signs and nurse's clinical assessment, was compared to ADAPT.
• Primary endpoint was 30-day mortality with a non-inferiority margin of 0.5%; predictive performance assessed via Receiver Operator Characteristics.

Main Results:

• CTA met non-inferiority criteria for 30-day mortality (3.42% vs. 3.43%, P = 0.996).
• CTA showed superior predictive performance for 30-day mortality (AUC 0.67 vs. 0.64, P = 0.03).
• No significant differences observed in ICU admission, length of stay, waiting times, or readmission rates.

Conclusions:

• The novel CTA, integrating vital signs and clinical assessment, is non-inferior to traditional triage algorithms for short-term mortality.
• CTA demonstrates superior accuracy in predicting 30-day mortality in emergency department settings.