Validation of the Gothenburg obstetric triage system

Obstetric emergency triage is a relatively new form of emergency triage and not yet fully implemented within obstetric emergency care. In addition to assessing both the pregnant patient and fetus, obstetric triage systems require adaptation to the physiological changes of pregnancy. Without adapted triage systems, obstetric patients are known to receive unequal care compared to non-obstetric emergency patients, resulting in avoidable adverse outcomes. This study aims to validate the Gothenburg obstetric triage system, a five-level obstetric emergency system based on symptom presentations and vital sign parameters.

Consecutive medical charts from the obstetric emergency department at Sahlgrenska University Hospital between January 1-17 and June 1-17, 2021 were reviewed. Triage levels were dichotomized into urgent (red/orange) and nonurgent (yellow/green/blue) and assessed in relation to 31 previously established acuity outcome measures reflecting acuity in the moment of triage. Sensitivity and specificity as well as over- and undertriage were assessed for Gothenburg obstetric triage system (GOTS) in general and individual chief complaints. For undertriaged patients, deepened chart reviews were performed.

Of 1280 patient visits, the appropriate triage level had been assigned in 96% of the patient visits; 2.3% (29/1280) were undertriaged. Sensitivity and specificity were 0.62 (confidence interval [CI], 0.50-0.73) and 0.98 (CI, 0.97-0.99), respectively. Subjective symptom descriptions such as pain and dyspnea were prone to under- and overtriage.

We suggest a two-phase validation process with standardized acuity outcome measures and deepened chart reviews to assess validity of obstetric triage systems in a given obstetric context. We found that GOTS is a valid triage system in the studied context but also identified areas of further improvement.