Comparison of accuracy between Regional 4 Triage System and Emergency severity index and Canadian Triage and Acuity Scale in the emergency department of Saraburi Hospital
Keywords:
R4TS, Emergency Triage system, Validity, Diagnostic, Life-saving interventionAbstract
Saraburi Hospital has been using a triage system called the "Regional 4 Triage System" (R4TS) since 2013. R4TS was adapted from two standard triage systems, the Emergency Severity Index (ESI) and the Canadian Triage and Acuity Scale (CTAS).
The purpose of this study was to investigate the accuracy and prediction of life-saving intervention in level 1 triage of the R4TS compared with the ESI, and the CTAS.
This diagnostic accuracy study took place at Saraburi Hospital, collecting data from patients who visited the Emergency Department in August and September 2021. Index cases (R4TS, CTAS, and ESI) were triaged at the unit and compared to reference triage assessed by two highly experienced emergency physicians. Life-saving interventions at level 1 triage were also collected and analyzed.
The study enrolled 200 participants. R4TS exhibited the highest overall validity at 69.00%, followed by ESI at 65.00%, and CTAS at 63.00%. In level 1, R4TS, ESI and CTAS had good validity above 70%. R4TS had the highest validity in levels 2-4, while CTAS was highest at level 1. The diagnostic odds ratio for R4TS was 408.50 (95% CI: 48.44-3,444.95) at level 1 and 31.96 (95% CI: 13.81-73.96) at level 2. R4TS showed the highest sensitivity, specificity, positive predictive value, and positive likelihood ratio at level 1 (70.37%, 99.42%, 95.00%, and 121.74%, respectively). Life-saving intervention prediction was consistent across all three systems (AUC = 0.7962; 95% CI 0.7324-0.8487).
R4TS demonstrates validity and accuracy similar to standard triage systems (ESI and CTAS). It excels, particularly in level 1-2 triage, and exhibits a strong predictive capability for life-saving interventions.
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