Triage: Limitations in predicting need for emergent care and hospital admission
Triage: Limitations in predicting need for emergent care and hospital admission
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DOI：
10.1016/s0196-0644(96)70240-8
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发表时间：
1996-04-01
影响因子：
6.2
通讯作者：
Skipper, BJ
中科院分区：
文献类型：
--
作者：
Brillman, JC;Doezema, D;Skipper, BJ
研究目的：目前对现有分诊方法的准确性和可靠性知之甚少。我们检查了观察者对急诊护理需求和在分诊时预测入院需要的能力的一致性，并将这些结果与医学评估和管理后的入院率进行比较。方法：我们采用交叉设计，其中每个受试者首先接受护士或计算机引导的分诊，其次接受其他类型的分诊，最后进行医生分诊。我们的原假设：分类方法将产生相同的结果。我们的患者是大学附属县转诊中心急诊科患者的连续样本。重症患者被排除在外。检查分诊分类的观察者间一致性（kappa 统计）和入院预测（敏感性、特异性和预测值）。结果：在参与研究的 5,106 名患者中，289 名 (6.2%) 入院。关于分诊分类的一致性，我们发现医生分诊与护士分诊 (SE+/-012) 和计算机分诊 (SE+/-012) 相比，kappa 值分别为 0.452 和 0.185（kappa 值之间的差异 P=.001）。护士预测入院的敏感性和特异性分别为 41.3 和 93.8；医生分别为 61.6 和 87.1；计算机辅助分诊分别为 68.2 和 73.6。 结论：我们发现医生、护士和计算机程序在分诊决策方面存在很大差异。将三组的分诊决策与医学评估和管理后的实际数据进行比较表明，三组在预测哪些患者需要入院方面均表现不佳。在分诊方法标准化和验证之前，不应使用分诊决策来确定获得紧急护理的及时性。
Study objective: Little is known about the accuracy and reliability of current triage methods. We examined agreement among observers with regard to the need for ED care and the ability to predict at triage the need for admission to the hospital and compared these findings with admission rates after medical evaluation and management.Methods: We used a crossover design in which each subject was subjected to nurse or computer-guided triage first, the other type of triage second, and physician triage last. Our null hypothesis: Triage methods will yield the same results. Our patients were a consecutive sample of patients at the ED of a university-affiliated county referral center. Critically ill patients were excluded. Triage categorization was examined for interobserver agreement (kappa-statistic) and prediction of admission (sensitivity, specificity, and predictive values).Results: Of the 5,106 patients enrolled in the study, 289 (6.2%) were admitted. With regard to the agreement of triage categorizations, we found kappa-values of .452 and .185, respectively, for physician triage compared with nurse (SE+/-012) and computer triage (SE+/-012) (P=.001 for the difference between the kappa-values). Sensitivity and specificity in predicting admission were 41.3 and 93.8, respectively, for nurses; 61.6 and 87.1, respectively, for physicians; and 68.2 and 73.6, respectively, for computer-aided triage.Conclusion: We found great variability among physicians, nurses, and a computer program with regard to triage decisions. Comparison of the three groups' triage decisions with actual data after medical evaluation and management showed that none of the three performed well in predicting which patients required admission. Until triage methods are standardized and validated, triage decisions should not be used to determine the timeliness of access to emergency care.