Are 5-level triage systems improved by using a symptom based approach?-a Danish cohort study

Area of Science:

• Emergency Medicine
• Clinical Triage Systems
• Healthcare Quality Improvement

Background:

• Danish emergency departments utilize five-level triage systems, with variations in symptom inclusion.
• This study compares the Danish Emergency Process Triage (DEPT) system (vital signs + symptoms) against a vital signs-only adaptation (VITAL-TRIAGE).

Purpose of the Study:

• To validate and compare the prognostic performance of two 5-level triage systems in Danish emergency departments.
• To assess the impact of including presenting symptoms versus vital signs alone in triage accuracy.

Main Methods:

• Retrospective cohort study of 632,196 emergency department contacts (April 2012 - December 2015).
• Triage system urgency categories were compared against critical outcomes: 24-h ICU admission, 2-day mortality, critical illness diagnosis, 48-h surgery, 4-h discharge, and length of stay.

Main Results:

• DEPT showed significantly higher sensitivity than VITAL-TRIAGE for predicting 24-h ICU admission (0.79 vs 0.44), 2-day mortality (0.69 vs 0.37), critical illness diagnosis (0.48 vs 0.09), and 48-h surgery (0.30 vs 0.04).
• VITAL-TRIAGE had higher sensitivity for predicting discharge within 4 hours (0.99 vs 0.91).
• Higher urgency categories in both systems correlated with adverse outcomes.

Conclusions:

• The DEPT system, by including presenting symptoms, significantly enhances the prediction of patient urgency and adverse outcomes.
• DEPT demonstrates comparable prognostic performance to other established 5-level triage systems.
• Triage systems incorporating presenting symptoms offer superior predictive capabilities for critical patient outcomes.