Modification and Validation of a Complaint-Oriented Emergency Department Triage System: A Multicenter Observational...

Area of Science:

• Emergency Medicine
• Healthcare Systems Analysis
• Clinical Triage Research

Background:

• The Korean Triage and Acuity Scale (KTAS) is a widely used emergency department (ED) triage system.
• Improving the predictive performance of triage systems is crucial for patient outcomes.

Purpose of the Study:

• To modify and validate the KTAS to enhance its prediction accuracy for hospital outcomes.
• To develop a Modified KTAS (MKTAS) with improved performance over the original KTAS.

Main Methods:

• A retrospective observational study was conducted across three academic universities in South Korea.
• The Modified KTAS (MKTAS) was derived using patient chief complaints and selected modifiers.
• Performance was evaluated using Area Under the Receiver Operating Characteristics Curve (AUC) and test characteristics for hospital mortality, critical outcome, and admission prediction.

Main Results:

• MKTAS demonstrated significantly higher AUC values than KTAS for predicting hospital mortality (0.826 vs. 0.794), critical outcome (0.836 vs. 0.798), and admission (0.725 vs. 0.685).
• The study utilized large datasets with 272,402 visits for derivation and 128,831 for validation of MKTAS.
• MKTAS showed significant improvements in sensitivity for predicting hospital mortality and critical outcomes, and specificity for predicting admission.

Conclusions:

• The Modified KTAS (MKTAS) is a validated enhancement of the original KTAS.
• MKTAS exhibits superior discriminating ability in predicting key hospital outcomes.
• Ongoing evaluation and modification of triage systems are essential for continuous improvement in healthcare delivery.