Five-level triage systems are being utilized in Danish emergency departments with and without the use of presenting symptoms. The aim of this study was to validate and compare two 5-level triage systems used in Danish emergency departments: “Danish Emergency Process Triage” (DEPT) based on a combination of vital signs and presenting symptoms and a locally adapted version of DEPT (VITAL-TRIAGE) using vital signs only. This was a retrospective cohort using data from five Danish emergency departments. All patients attending an emergency department during the period of 1 April 2012 until 31 December 2015 were included. Validity of the two triage systems was assessed by comparing urgency categories determined by each triage system with critical outcomes: admission to Intensive care unit (ICU) within 24 h, 2-day mortality, diagnosis of critical illness, surgery within 48 h, discharge within 4 h and length of hospital stay. We included 632,196 ED contacts. Sensitivity for 24-h ICU admission was 0.79 (95% confidence interval 0.78–0.80) for DEPT and 0.44 (0.41–0.47) for VITAL-TRIAGE. The sensitivity for 2-day mortality was 0.69 (0.67–0.70) for DEPT and 0.37 (0.34–0.41) for VITAL-TRIAGE. The sensitivity to detect diagnoses of critical illness was 0.48 (0.47–0.50) for DEPT and 0.09 (0.08–0.10) for VITAL-TRIAGE. The sensitivity for predicting surgery within 48 h was 0.30 (0.30–0.31) in DEPT and 0.04 (0.04–0.04) in VITAL-TRIAGE. Length of stay was longer in VITAL-TRIAGE than DEPT. The sensitivity of DEPT to predict patients discharged within 4 h was 0.91 (0.91–0.92) while VITAL-TRIAGE was higher at 0.99 (0.99–0.99). The odds ratio for 24-h ICU admission and 2-day mortality was increased in high-urgency categories of both triage systems compared to low-urgency categories. High urgency categories in both triage systems are correlated with adverse outcomes. The inclusion of presenting symptoms in a modern 5-level triage system led to significantly higher sensitivity measures for the ability to predict outcomes related to patient urgency. DEPT achieves equal prognostic performance as other widespread 5-level triage systems.

中文翻译：

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使用基于症状的方法是否改进了 5 级分诊系统？——丹麦队列研究

丹麦急诊部门正在使用五级分诊系统，无论是否使用出现症状。本研究的目的是验证和比较丹麦急诊科使用的两个 5 级分诊系统：基于生命体征和出现症状的组合的“丹麦紧急程序分诊”（DEPT）和当地改编版本的 DEPT（VITAL -TRIAGE) 仅使用生命体征。这是一个回顾性队列，使用来自五个丹麦急诊科的数据。包括 2012 年 4 月 1 日至 2015 年 12 月 31 日期间在急诊科就诊的所有患者。通过将每个分流系统确定的紧急类别与关键结果进行比较来评估两个分流系统的有效性：24 小时内进入重症监护室 (ICU)、2 天死亡率、危重病诊断、48小时内手术，4小时内出院，住院天数。我们纳入了 632,196 名 ED 联系人。DEPT 的 24 小时 ICU 入院敏感性为 0.79（95% 置信区间 0.78-0.80），VITAL-TRIAGE 的敏感性为 0.44（0.41-0.47）。DEPT 的 2 天死亡率敏感性为 0.69 (0.67–0.70)，VITAL-TRIAGE 的敏感性为 0.37 (0.34–0.41)。DEPT 检测危重疾病诊断的敏感性为 0.48 (0.47–0.50)，VITAL-TRIAGE 为 0.09 (0.08–0.10)。在 DEPT 中预测 48 小时内手术的敏感性为 0.30（0.30-0.31），在 VITAL-TRIAGE 中为 0.04（0.04-0.04）。VITAL-TRIAGE 的停留时间比 DEPT 长。DEPT 预测 4 小时内出院患者的敏感性为 0.91（0.91-0.92），而 VITAL-TRIAGE 更高，为 0.99（0.99-0.99）。与低紧急类别相比，两种分诊系统的高紧急类别中 24 小时 ICU 入院和 2 天死亡率的优势比均有所增加。两种分类系统中的高紧急类别都与不良结果相关。在现代 5 级分诊系统中包含出现症状，从而显着提高了预测与患者紧迫性相关结果的能力的敏感性测量。DEPT 实现了与其他广泛使用的 5 级分诊系统相同的预后性能。