Ozlem DİKME, Rıdvan ATİLLA, Nese COLAK ORAY, Gulcim SARACOGLU, Mehmet Can GİRGİN, Pınar Yesim AKYOL

Dokuz Eylül Triyaj Sistemi: Beş kategorili triyaj algoritmi, geçerlilik ve güvenilirlik çalışması

Giriş: Triyaj sistemleri, acil servis bekleme alanlarında hastalığın ciddiyetini tespit etmede faydalı araçlardır. Hastalık ve hasta profili açısından benzerlik eksikliği nedeniyle, her triyaj sistemi başka bir ülkede etkili olmayabilir. Dokuz Eylül Triyaj Sistemi beş seviyeli bir triyaj sistemi olarak geliştirildi ve bu yazıda Dokuz Eylül Triyaj Sistemi üçüncü seviye bir acil serviste kullanılarak geçerliliği ve güvenilirliği değerlendirildi. Yöntem: Bu çalışma üçüncü basamak acil serviste yapıldı. Çalışmaya bir ay içerisinde acil servise başvuran ve sistematik örnekleme yöntemi ile seçilen hastalar alındı. Hastane yatışı, acil serviste kalış süresi, 48 saat sonundaki mortalite, kaynak kullanımları geçerlilik için değerlendirildi ve kör eşleştirilmiş triyaj kategorileri güvenilirlik için ağırlıklı kappa analizi ile karşılaştırıldı. Bulgular: Beş yüz altmış yedi hasta çalışmaya alındı; 30'u dışlandı. Kalan 537 hastanın %55'i kadındı ve ortanca yaş 46 idi. Hastalardan yedisinin triyaj seviyesi-1 (%1.3), 142'sinin triyaj seviyesi-2 (%26.4), 167'sinin triyaj seviyesi-3 (%31.1), 166'sının triyaj seviyesi-4 (%30.9) ve 55'inin triyaj seviyesi-5 (%10,3) bulundu. Triyaj kategorileri için ağırlıklı kappa, 0.825 olarak bulundu. Triyaj kategoriri kaynak kullanımı, hastanede yatış oranları, ortalama kalış süresi ve 48 saat mortalite, triyaj seviyesi ile kuvvetli olarak ilişkili bulundu. Aşırı triyaj oranı %15,5, triyaj altı oranı %3,7 ve triyaj sisteminin triyaj kategorisi 1 ve 2'deki hastalar için duyarlılığı %99,3 ve özgüllüğü %96 olarak hesaplandı. Sonuçlar: Dokuz Eylül Triyaj Sistemi, bir üçüncü derece acil serviste klinik uygulamaya yerleştirilecek kadar güvenilir ve geçerli beş kategorili bir triyaj algoritmasıdır. Dokuz Eylül Triyaj Sisteminin, canlandırma ve acil bakım ihtiyacı olan hastaları güvenle tespit edip eleyebildiği bu çalışma ile rapor edilmiştir.

Anahtar Kelimeler:

Triyaj, geçerlilik, güvenilirlik

Dokuz Eylul Triage System: A five category triage algorithm, reliability and validity study.

Introduction: Triage systems are useful tools to detecting severity of illness in the emergency department’s waiting areas. Because of the lack of similarity in terms of disease and the patient profile each triage system may not be effective in another country. Dokuz Eylul Triage System was developed as a five-level triage system and this paper evaluates validity and reliability of Dokuz Eylul Triage System to use in a tertiary Turkish emergency department. Methods: This study was performed in a tertiary emergency department. Patients with any symptoms who were admitted to the emergency department in one-month period and selected by systematic sampling method were included into the study. Hospital admission, length of stay in the emergency department, 48h mortality, resource uses were assessed for validity and blinded paired triage assignments were compared with weighted kappa analysis for reliability. Results: Five-hundred-sixty-seven patients were enrolled; 30 were excluded. The resulting of 537 patients was 55% female and had a median age of 46 years. Seven of them were triage level-1 (1.3%), 142 of them were level-2 (26.4%), 167 of them were level-3 (31.1%), 166 of them were level-4 (30.9%) and 55 of them were level-5 (10.3%). Weighted kappa for triage assignment was found as 0.825. Resource use, hospitalization rates, mean length of stay and 48h mortality were found as strongly associated with triage level. Over-triage rate was 15.5%, under-triage rate was 3.7% and the sensitivity and specificity of the triage system were calculated 99.3% and 96%. Conclusions: Dokuz Eylul Triage System is a reliable and validated five-category triage algorithm for Turkey to be implanted into clinical practice of a tertiary emergency department. We report that Dokuz Eylul Triage System could be able to detect and sieve the patients safely who need resuscitation and emergent care.

Keywords:

triage, reliability, validity,

PDF

___

1.Dong SL, Bullard M. Emergency department triage. In Rowe B, Lang E, Brown M (eds): Evidence-Based Emergency Medicine. Oxford, Wiley-Blackwell, 2009, pp:58–65.
2.Berner AR. Triage. In Hendey GW, Cloutier RL, Ling LJ (eds): Harwood-Nuss' Clinical Practice of Emergency Medicine. 6th edition. Philadelphia, Lippincott Williams & Wilkins, 2014, pp:1716–18.
3.Mackway-Jones K. Emergency triage, 2nd edition: Manchester Triage Group. Blackwell Publishing Ltd, UK, 2006.
4.Beveridge R, Clarke B, Janes L et al. Implementation guidelines for the Canadian Emergency Department Triage & Acuity Scale (CTAS). Endorsed by the Canadian Association of Emergency Physicians (CAEP), the National Emergency Nurses Affiliation of Canada (NENA), and L'association des médecins d'urgence du Québec (AMUQ). Version: CTAS16.Doc December 16, 1998. http://www.caep.ca (accessed 21 July 2019).
5.Bullard MJ, Unger B, Spence J et al. Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines. CJEM 2008;10(2):136–42.
6.Australian College of Emergency Medicine. Guidelines for the implementation of the Australian Triage Score. Australian College of Emergency Medicine, 1998. http://www.acem.org.au (accessed 21 July 2019).
7.Cameron PA, Bradt DA, Ashby R. Emergency medicine in Australia. Ann Emerg Med 1996;28(3):342–6.
8.McCallum Pardey TG. The clinical practice of emergency department triage: Application of the Australasian Triage Scale-An extended literature review part I: Evolution of the ATS. Australas Emerg Nurs J 2006;9:155–62.
9.Wurz RC, Milne LW, Eitel DR et al. Reliability and Validity of a new five-level triage instrument. Acad Emerg Med 2000;7:236-42.
10.Eitel DR, Travers DA, Rosenau AM et al. The Emergency Severity Index triage algorithm Version 2 is reliable and valid. Acad Emerg Med 2003;10(10):1070–80.
11.Tanabe P, Gimbel R, Yarnold PR et al. Reliability and validity of scores on the Emergency Severity Index Version 3. Acad Emerg Med 2004;11(1):59–65.
12.Taboulet P, Moreira V, Haas L et al. Triage with the french emergency nurses classification in hospital scale: Reliability and validity. Eur J Emerg Med 2009;16(2):61–7.
13.Streiner D, Norman G. Health Measurement Scales. A Practical Guide to Their Development and Use.4th ed. New York, Oxford University Press, 2008.
14.Beveridge R, Ducharme J, Janes L et al. Reliability of the Canadian emergency department triage and acuity scale: interrater agreement. Ann Emerg Med 1999;34(2):155-9.
15.Tanabe P, Gimbel R, Yarnold PR et al. The Emergency Severity Index (Version 3) 5-level triage system scores predict ED resource consumption. J Emerg Nurs 2004;30(1):22–9.
16.Wuerz RC, Travers D, Gilboy N et al. Implementation and refinement of the Emergency Severity Index. Acad Emerg Med 2001;8:170–176.
17.Veen M, Steyerberg EW, Ruige M et al. Manchester Triage System in paediatric emergency care: Prospective observational study. BMJ 2008;337:a1507.
18.Jiménez JG, Murray MJ, Beveridge R et al: Implementation of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the principality of Andorra: Can triage parameters serve as emergency department quality indicators? CJEM 2003;5(5):315–22.
19.Considine J, LeVasseur SA, Villanueva E. The Australasian Triage Scale: Examining emergency department nurses’ performance using computer and paper scenarios. Ann Emerg Med 2004;44(5):516–23.
20.Beveridge R, Ducharme J, Janes L et al. Reliability of the Canadian Emergency Department Triage and Acuity Scale: Interrater agreement. Ann Emerg Med 1999;34(2):155–9.
21.Jobé J, Ghuysen A, Gérard P et al. Reliability and validity of a new French-language triage algorithm: the ELISA scale. Emerg Med J 2014;31:115-120.
22.Dalwai M K, Twomey M, Maikere J et al. Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan. S Afr Med J 2014;104(5):372-375.
23.Worster A, Fernandes CM, Eva K et al. Predictive validity comparison of two five-level triage acuity scales. Eur J Emerg Med 2007;14(4):188-92.
24.Erimsah ME, Yaka E, Yılmaz S, Kama A, Pekdemir M. Inter-rater reliability and validity of the Ministry of Health of Turkey's mandatory emergency triage instrument. Emergency Medicine Australasia 2015;27:210-215.
25.Ozucelik DN, Kunt MM, Karaca MA, Erbil B, Sivri B, Sahin A, Sardan YC, Ozmen MM, Doğan BG. A model of complaint based for overcrowding emergency department: Five-Level Hacettepe Emergency Triage System. Ulus Travma Acil Cerrahi Derg 2013;19(3):205-214.