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The Copenhagen Triage Algorithm is non-inferior to a traditional triage algorithm: A cluster-randomized study

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  • Rasmus Bo Hasselbalch
  • Mia Pries-Heje
  • Martin Schultz
  • Louis Lind Plesner
  • Lisbet Ravn
  • Morten Lind
  • Rasmus Greibe
  • Birgitte Nybo Jensen
  • Thomas Høi-Hansen
  • Nicholas Carlson
  • Christian Torp-Pedersen
  • Lars S Rasmussen
  • Kasper Iversen
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Introduction Triage systems with limited room for clinical judgment are used by emergency departments (EDs) worldwide. The Copenhagen Triage Algorithm (CTA) is a simplified triage system with a clinical assessment. Methods The trial was a non-inferiority, two-center cluster-randomized crossover study where CTA was compared to a local adaptation of Adaptive Process Triage (ADAPT). CTA involves initial categorization based on vital signs with a final modification based on clinical assessment by an ED nurse. We used 30-day mortality with a non-inferiority margin at 0.5%. Predictive performance was compared using Receiver Operator Characteristics. Results We included 45,347 patient visits, 23,158 (51%) and 22,189 (49%) were triaged with CTA and ADAPT respectively with a 30-day mortality of 3.42% and 3.43% (P = 0.996) a difference of 0.01% (95% CI: -0.34 to 0.33), which met the non-inferiority criteria. Mortality at 48 hours was 0.62% vs. 0.71%, (P = 0.26) and 6.38% vs. 6.61%, (P = 0.32) at 90 days for CTA and ADAPT. CTA triaged at significantly lower urgency level (P<0.001) and was superior in predicting 30-day mortality, Area under the curve: 0.67 (95% CI 0.65-0.69) compared to 0.64 for ADAPT (95% CI 0.62-0.66) (P = 0.03). There were no significant differences in rate of admission to the intensive care unit, length of stay, waiting time nor rate of readmission within 30 or 90 days. Conclusion A novel triage system based on vital signs and a clinical assessment by an ED nurse was non-inferior to a traditional triage algorithm by short term mortality, and superior in predicting 30-day mortality.

Original languageEnglish
Article numbere0211769
JournalPLoS One
Volume14
Issue number2
Pages (from-to)e0211769
ISSN1932-6203
DOIs
Publication statusPublished - 1 Feb 2019

ID: 56745331