Triage and triage related work has been performed in Swedish Emergency Departments (EDs) since the mid-1990s. The Rapid Emergency Triage and Treatment System (RETTS©), with annual updates, is the most applied triage system. However, the national implementation has been performed despite low scientific foundation for triage as a method, mainly related to the absence of adjustment to age and gender. Furthermore, there is a lack of studies of RETTS© in Swedish ED context, especially of RETTS© validity. Hence, the aim the study was to determine the validity of RETTS©. A longitudinal retrospective register study based on cohort data from a healthcare region comprising two EDs in southern Sweden. Two editions of RETTS© was selected; year 2013 and 2016, enabling comparison of crude data, and adjusted for age-combined Charlson comorbidity index (ACCI) and gender. All patients ≥ 18 years visiting either of the two EDs seeing a physician, was included. Primary outcome was ten-day mortality, secondary outcome was admission to Intensive Care Unit (ICU). The data was analysed with descriptive, and inferential statistics. Totally 74,845 patients were included. There was an increase in patients allocated red or orange triage levels (unstable) between the years, but a decrease of admission, both to general ward and ICU. Of all patients, 1031 (1.4%) died within ten-days. Both cohorts demonstrated a statistically significant difference between the triage levels, i.e. a higher risk for ten-day mortality and ICU admission for patients in all triage levels compared to those in green triage level. Furthermore, significant statistically differences were demonstrated for ICU admission, crude as well as adjusted, and for adjusted data ten-day mortality, indicating that ACCI explained ten-day mortality, but not ICU admission. However, no statistically significant difference was found for the two annual editions of RETTS© considering ten-day mortality, crude data. The annual upgrade of RETTS© had no statistically significant impact on the validity of the triage system, considering the risk for ten-day mortality. However, the inclusion of ACCI, or at least age, can improve the validity of the triage system.

中文翻译：

---

对瑞典成人 ED 上下文版本 RETTS© 进行的纵向、回顾性注册验证研究


自 20 世纪 90 年代中期以来，瑞典急诊科 (ED) 一直在开展分诊和分诊相关工作。快速紧急分诊和治疗系统 (RETTS©) 每年更新一次，是应用最广泛的分诊系统。但分诊方法在全国范围内的实施，其科学依据并不充分，主要与没有对年龄和性别进行调整有关。此外，在瑞典 ED 背景下缺乏对 RETTS© 的研究，特别是对 RETTS© 有效性的研究。因此，本研究的目的是确定 RETTS© 的有效性。一项纵向回顾性登记研究，基于来自瑞典南部两个急诊室的医疗保健区域的队列数据。 RETTS© 的两个版本被选中； 2013 年和 2016 年，可以比较原始数据，并根据年龄组合查尔森合并症指数 (ACCI) 和性别进行调整。所有年龄≥ 18 岁、到两个急诊室就诊的患者均被纳入其中。主要结局是十天死亡率，次要结局是入住重症监护病房（ICU）。通过描述性和推论性统计分析数据。总共纳入了 74,845 名患者。多年来，分配红色或橙色分诊级别（不稳定）的患者有所增加，但入院人数有所减少，无论是普通病房还是 ICU。在所有患者中，1031 名患者（1.4%）在 10 天内死亡。两个队列都显示出分诊级别之间存在统计学上的显着差异，即与绿色分诊级别的患者相比，所有分诊级别的患者十天死亡率和入住 ICU 的风险更高。 此外，ICU 入院（粗略和调整后）以及调整后的 10 天死亡率数据存在显着的统计差异，表明 ACCI 解释了 10 天死亡率，但不能解释 ICU 入院。然而，考虑到十天死亡率的粗略数据，RETTS© 的两个年度版本没有发现统计上的显着差异。考虑到十天死亡率的风险，RETTS© 的年度升级对分诊系统的有效性没有统计上的显着影响。然而，纳入 ACCI 或至少年龄可以提高分诊系统的有效性。