2019
Performance of triage systems in emergency care: a systematic review and meta-analysis
Publication
Publication
BMJ Open , Volume 9 - Issue 5
Objective
To assess and compare the performance
of triage systems for identifying high and low-urgency
patients in the emergency department (ED).
Design Systematic review and meta-analysis.
Data sources EMBASE, Medline OvidSP, Cochrane
central, Web of science and CINAHL databases from 1980
to 2016 with the final update in December 2018.
Eligibility criteria Studies that evaluated an emergency
medical triage system, assessed validity using any
reference standard as proxy for true patient urgency and
were written in English. Studies conducted in low(er)
income countries, based on case scenarios or involving
less than 100 patients were excluded.
Review methods
Reviewers identified studies,
extracted data and assessed the quality of the evidence
independently and in duplicate. The Quality Assessment
of studies of Diagnostic Accuracy included in Systematic
Reviews -2 checklist was used to assess risk of bias. Raw
data were extracted to create 2×2 tables and calculate
sensitivity and specificity. ED patient volume and casemix
severity of illness were investigated as determinants of
triage systems’ performance.
Results
Sixty-six eligible studies evaluated 33 different
triage systems. Comparisons were restricted to the three
triage systems that had at least multiple evaluations using
the same reference standard (Canadian Triage and Acuity
Scale, Emergency Severity Index and Manchester Triage
System). Overall, validity of each triage system to identify
high and low-urgency patients was moderate to good, but
performance was highly variable. In a subgroup analysis,
no clear association was found between ED patient
volume or casemix severity of illness and triage systems’
performance.
Conclusions
Established triage systems show a
reasonable validity for the triage of patients at the ED,
but performance varies considerably. Important research
questions that remain are what determinants influence
triage systems’ performance and how the performance of
existing triage systems can be improved.
Additional Metadata | |
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doi.org/10.1136/bmjopen-2018-026471, hdl.handle.net/1765/117827 | |
BMJ Open | |
Organisation | Erasmus MC: University Medical Center Rotterdam |
Zachariasse, J.M., van der Hagen, V., Seiger, N., Mackway-Jones, K., Veen, M., & Moll, H. (2019). Performance of triage systems in emergency care: a systematic review and meta-analysis. BMJ Open, 9(5). doi:10.1136/bmjopen-2018-026471 |