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Background:
The Canadian Triage and Acuity Scale is a valid triage system. The system was translated and implemented in the Japanese emergency departments (EDs) from 2012. This system was named the Japanese Triage and Acuity Scale; however, the validation studies of the Japanese Triage and Acuity Scale have been limited. In addition, for a patient...
Context in source publication
Context 1
... distributions of the triage levels among the 17,121 cases were as follows: level 1, 451 (2.6 %); level 2, 1148 6.7 %); level 3, 7703 (45.0 %); level 4, 7652 (44.7 %); and level 5, 167 (1.0 %). Table 2 shows the patient character- istics by each triage level. Table 3 To analyze the relationship between the mJTAS triage level and the TARs, we developed a logistic regression model. ...
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Aims:
In patients with palliative end-stage heart failure, interventions that could provide symptomatic relief and prevent hospital admissions are important. Ambulatory continuous intravenous inotropes have been advocated by guidelines for such a purpose. We sought to determine the effect of intravenous dobutamine on symptomatic status, hospital s...
Citations
... All patients visiting the ED undergo triage, which is based upon the modified Japanese Triage and Acuity Scale (mJTAS) [9]. The triage nurse, after measuring the vital signs of a patient and obtaining a short medical history, labels the patient with one of the following triage colours: Unstable haemodynamic patients are always referred for monitoring. ...
Background: Though out-of-hospital CA (OHCA) is widely reported, data on in-hospital CA (IHCA) and especially cardiac arrest (CA) in the emergency department (CAED) are scarce. This study aimed to determine the frequency, prevalence, and clinical features of unexpected CAED and compare the data with those of expected CAED. Methods: We defined unexpected CAED as CA occurring in patients in non-critical ED-care areas; classified as not requiring strict monitoring. This classification was the modified Japanese Triage and Acuity Scale and physician assessment. A retrospective analysis of cases from 2016 to 2018 was performed, in comparison to other patients experiencing CAED. Results: The 38 cases of unexpected CA in this study constituted 34.5% of CA diagnosed in the ED and 8.4% of all CA treated in the ED. This population did not differ significantly from other CAED regarding demographics, comorbidities, and survival rates. The commonest symptoms were dyspnoea, disorders of consciousness, generalised weakness, and chest pain. The commonest causes of death were acute myocardial infarction, malignant neoplasms with metastases, septic shock, pulmonary embolism, and heart failure. Conclusions: Unexpected CAED represents a group of potentially avoidable CA and deaths. These patients should be analysed, and ED management should include measures aimed at reducing their incidence.
... The Emergency Department (ED) is a pivotal healthcare entry point and is the busiest department in all hospitals worldwide.The ED has an excessive flow of complicated, often life-threatening cases and a high density of critical clinical decision-making. 1 Statistics of the Mahosot Hospital, the largest hospital in the Lao People's Democratic Republic (Lao PDR), showed the overall rise over five years (2011-2016) was 29.12%. 2 Triage is a treatment process for the timely delivery of emergency care, handling emergencies with an appropriate allocation of medical resources, and sorting for ED treatment. 3,4 The triage concept is used in modern healthcare systems worldwide. 5 The triage system helps patients with lifethreatening illnesses access care first for medical services. ...
... 6 Triage ensures resources are allocated where they are most needed. 3,4,7 Despite the well-established benefits of triage, no hospital has fully implemented the triage system. 8,9 The triage system in the Lao PDR employs three different models, the model of clinical experience (Look, Listen and Feel), three zones of patient screening (emergent, urgent, and non-urgent or color codes: red, yellow and green); or an emergency severity index (ESI with five scales). ...
Objective: To assess the present status of the emergency department (ED) triage system in 162 hospitals across the Lao People's Democratic Republic (Lao PDR). Materials and Methods: The Lao PDR nationwide survey participants recruited ED administrators. The EDs were randomly recruited. The standard questionnaire package was used for data collection including patients’ demographics and triage systemic factors. Descriptive analysis was applied to analysis the outcome of interest. Results: A majority of triage officers were emergency room nurses (58.6%), general physicians (20.4%), or both (11.1%). Most hospitals (89.5%) used informal triage scales such as clinical experiences or colors to prioritize ED patients. Only 17 hospitals (10.5%) had a formal triage scale in their ED care systems and used it in their practice. Conclusion: These findings provide knowledge of the ED triage system in the Lao PDR. The results indicate that the Lao PDR lacks a formal ED triage scale but uses a variety of informal scales. Thus, it is necessary to set up a standard triage system at all hospitals to standardize ED healthcare across the country.
... The primary exposure of interest was the level of consciousness at hospital arrival. The level of impaired consciousness was evaluated using the Glasgow Coma Scale (GCS) and the results were classified three groups: mild (GCS of [13][14][15], moderate (GCS of 9-12), or severe (GCS < 9). In Japan, the level of impaired consciousness is also evaluated using the Japan Coma Scale (JCS), which consists of eyeopening to stimuli, similar to the "eye" component of the GCS. ...
... 8,9 The reason we used categorized levels of consciousness is that, in most prehospital severity assessment protocols used by emergency medical services in Japan and the Japan Triage and Acuity Scale used in the emergency department, the level of consciousness is categorized as based on GCS or JCS. 12,15 Thus, we believe that categorized levels of consciousness make it easier to interpret the results. ...
Aim:
This study aimed to investigate the association between level of impaired consciousness and severe hypothermia (<28°C) and to evaluate the association between level of impaired consciousness and inhospital mortality among accidental hypothermia patients.
Methods:
This was a multicenter retrospective study using the J-Point registry database, which includes data regarding patients whose core body temperature was 35.0°C or less and who were treated as accidental hypothermia in emergency departments between April 1, 2011 and March 31, 2016. We estimated adjusted odds ratios of the level of impaired consciousness for severe hypothermia less than 28°C and inhospital mortality using a logistic regression model.
Results:
The study included 505 of 572 patients in the J-Point registry. Relative to mildly impaired consciousness (Glasgow Coma Scale [GCS] 13-15), the adjusted odds ratios for severe hypothermia less than 28°C were: moderate (GCS 9-12), 3.26 (95% confidence interval [CI], 1.69-6.25); and severe (GCS < 9), 4.68 (95% CI, 2.40-9.14). Relative to mildly impaired consciousness (GCS 13-15), the adjusted odds ratios for inhospital mortality were: moderate (GCS9-12), 1.65 (95% CI, 0.95-2.88); and severe (GCS < 9), 2.10 (95% CI, 1.17-3.78).
Conclusion:
The level of impaired consciousness in patients with accidental hypothermia was associated with severe hypothermia and inhospital mortality.
... These revisions are in agreement with the results of previous studies. [23][24][25] The modified JTAS considers GCS ≤ 9 as level 1. 23 The Ohio emergency medical service system changed its trauma triage cutoff for older adults from a GCS score of 13 to 14. 24 Revising GCS scores from 13 to 14 for older patients may improve the identification of those with serious injuries. 25 Respiratory rate is a significant vital sign. ...
... These revisions are in agreement with the results of previous studies. [23][24][25] The modified JTAS considers GCS ≤ 9 as level 1. 23 The Ohio emergency medical service system changed its trauma triage cutoff for older adults from a GCS score of 13 to 14. 24 Revising GCS scores from 13 to 14 for older patients may improve the identification of those with serious injuries. 25 Respiratory rate is a significant vital sign. ...
Objective:
Because of physiologic changes in older adults, their vital signs need to be assessed differently. This study aimed to determine appropriate vital sign cut points for triage designation in older patients presented to the emergency department (ED).
Patients and methods:
Data from 78,524 ED visits of patients aged ≥65 years in Linkou Chang Gung Memorial Hospital (LCGMH) between 2016 and 2017 were collected. New cut points for vital signs (systolic blood pressure [SBP], heart rate [HR], body temperature [BT], and Glasgow Coma Scale [GCS]) were determined using the critical event rate (the composite of admission to ICU and mortality in hospital) for each vital sign. The newly proposed triage scale was then validated using two other databases (Chang Gung Research Database [CGRD] and Taipei City Hospital [TPECH] database). The Taiwan Triage and Acuity Scale (TTAS) was used in this study.
Results:
In the LCGMH derivation group, older patients presenting with SBP < 80 mmHg, HR < 40 or > 140 beats per minute (bpm), BT < 35°C, and GCS score 3-8 had a critical event rate of >20% and were proposed to be uptriaged to TTAS level 1. Following a reclassification, a portion of older patients are uptriaged by the newly proposed TTAS, and increase in the critical event rate in TTAS level 1 and level 2 groups compared to the existing TTAS. The newly proposed TTAS exhibited comparable discriminatory ability for triage in older patients compared to the existing TTAS (the area under the receiver operating characteristics curve: CGRD, 0.76 vs 0.62; TPECH, 0.71 vs 0.59).
Conclusion:
Revising the vital signs triage criteria for older patients could be a way to improve the identification of patients with critical event outcomes in high TTAS level, thereby improving triage accuracy among older patients visiting the ED.
... A patient in level 5 is not in an urgent situation. Such patients may have a chronic disorder and have a low possibility of deterioration [11][12][13][14]. ...
Introduction:
Proper ambulance use is important not only due to the patient's transport quality but also because of the need for efficient use of limited resources allotted by the system. Therefore, this study was conducted to check for overuse or underuse of the ambulance system by patients who visited the emergency department (ED).
Methods:
In this study, a secondary data analysis was conducted using the existing database of the National Emergency Department Information System with all patients who visited EDs over the three-year study period from 2016 to 2018. The study subjects were classified into the following groups: (1) appropriate Emergency Medical Services (EMS) usage; (2) appropriate no EMS usage; (3) underuse; and (4) overuse groups.
Results:
Of 18,298,535 patients, 11,668,581 (63.77%) were classified under the appropriate usage group, while 6,629,954 (36.23%) were classified under the inappropriate usage group. In the appropriate EMS usage group, there were 2,408,845 (13.16%) patients. In the appropriate no EMS usage group, there were 9,259,706 (50.60%) patients. As for the inappropriate usage group, there were 5,147,352 (28.13%) patients categorized under the underuse group. On the other hand, there were 1,482,602 (8.10%) patients under the overuse group.
Conclusion:
There are many patients who use ambulances appropriately, but there are still many overuse and underuse. Guidelines on ambulance use are necessary for the efficient use of emergency medical resources and for the safety of patients.
... The recorded chief complaints are automatically translated into 231 chief complaints' categories based on the JTAS, 20 which was developed based on the Canadian Triage and Acuity System. 16 For the medical history and physician's diagnoses, practitioners record these data to each prespecified field, and the NSER system abstracts the information and applies ICD-10 codes. For the medication data, the NSER system encodes using the WHO's Anatomical Therapeutic Chemical Classification System (ATC). ...
Aim
Emergency department information systems (EDIS) facilitate free‐text data use for clinical research; however, no study has validated whether the Next Stage ER system (NSER), an EDIS used in Japan, accurately translates electronic medical records (EMRs) into structured data.
Methods
This is a retrospective cohort study using data from the emergency department (ED) of a tertiary care hospital from 2018 to 2019. We used EMRs of 500 random samples from 27,000 ED visits during the study period. Through the NSER system, chief complaints were translated into 231 chief complaint categories based on the Japan Triage and Acuity Scale. Medical history and physician’s diagnoses were encoded using the International Classification of Diseases, 10th Revision; medications were encoded as Anatomical Therapeutic Chemical Classification System codes. Two reviewers independently reviewed 20 items (e.g., presence of fever) for each study component (e.g., chief complaints). We calculated association measures of the structured data by the NSER system, using the chart review results as the gold standard.
Results
Sensitivities were very high (>90%) in 17 chief complaints. Positive predictive values were high for 14 chief complaints (≥80%). Negative predictive values were ≥96% for all chief complaints. For medical history and medications, most of the association measures were very high (>90%). For physicians’ ED diagnoses, sensitivities were very high (>93%) in 16 diagnoses; specificities and negative predictive values were very high (>97%).
Conclusions
Chief complaints, medical history, medications, and physician’s ED diagnoses in EMRs were well‐translated into existing categories or coding by the NSER system.
... Although we found no difference in the KTAS score of the admitted patients between the two periods, the KTAS and the CTAS are used as initial triage tools rather than prognostic tools in the ED [21]. However, some studies have reported that the score has a strong association with prognoses, such as mortality and ICU admission rates [29,30]. ...
Background:
Emergency department (ED) overcrowding is a worldwide problem that poses a threat to patient safety by causing treatment delays and increasing mortality. Consultations are common and important in the emergency medicine profession and are associated with longer ED length of stay (LOS). The purpose of this study was to evaluate the impact of admission decisions by emergency physicians without consultations on the ED LOS and other quality indicators.
Methods:
The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions that was implemented in October 2016. During and after the policy change, emergency physicians decided how to arrange for and treat medical patients by processing their admission and providing follow-up care without consultations. The ED LOS and other indicators of patients admitted to the IM department were compared between the study period (January to June 2017) and the control period (January to June 2016).
Results:
The median ED LOS of patients admitted to the IM department decreased from 673 (IQR: 347-1,369) minutes in the control period to 237 (IQR: 166-364) minutes in the study period. There were no significant differences in the interdepartmental transfer rate or in-hospital mortality between the two periods.
Conclusions:
The admission decisions regarding medical patients made by emergency physicians without specialty consultations reduced the ED LOS without a significant negative effect on mortality or hospital LOS.
... This triage system has proven validity. 12 The secondary outcomes were length of stay, method of arrival to the hospital, and discharge diagnosis. The length of stay was defined as minutes between reception and leaving ED. ...
... Although the population pyramid of the Urayasu-Ichikawa area is quite similar to the national population pyramid, the localized nature of the study could limit the generalizability of the results. 12 A larger multicenter study is necessary to confirm the present findings. ...
Aim
Little evidence on Japanese frequent presenters (FPs) is available. Therefore, this retrospective cohort study compared characteristics between FPs and non‐frequent presenters (NFPs) in emergency departments (EDs) in Japan.
Methods
Frequent presenters included those who presented to an ED ≥4 times during the study period from August 1, 2012 to July 21, 2013. The primary outcomes were triage level and disposition. Secondary outcomes were ED length of stay, method of arrival, and discharge diagnosis.
Results
During the study period, 195 FPs had 1,154 visits to the ED, compared to 15,953 visits by 13,838 NFPs. The sex distribution between FPs and NFPs was comparable (107 men [54.9%] versus 7,070 men [51.1%], respectively; P = 0.29), but the mean age was significantly higher in the FP group (57.3 versus 46.5 years, respectively; P < 0.0001). Among the FPs, the rate of free governmental health insurance was higher than that of those who pay 30% of health costs (35 patients paid 0% [79.5%] versus 109 patients paid 30% [42.6%], respectively). Condition severity (FP, 84 severe cases [7.28%]; NFP, 1,320 severe cases [8.27%], respectively) and rate of admission (FP, 207 admissions [17.9%]; NFP, 2,987 admissions [18.7%], respectively) were comparable between the groups, although the rate of ambulance use was lower for the FP group. The most frequent diagnostic codes (International Classification of Diseases, 10th Revision) in the FP group were “symptoms and signs”.
Conclusion
Triage levels and hospital admission rates were not significantly different between FPs and NFPs in this single‐center study in Japan.
... On peut citer un malaise, une douleur aiguë céphalique, thoracique, abdominale ou pelvienne, une hémorragie extériorisée non active, une lésion traumatologique avec déformation modérée ou impotence fonctionnelle totale… La prise en charge médico-infirmière conduit à la réalisation d'environ trois actes hospitaliers (exemple : perfusion d'antalgiques, prélèvement biologique, imagerie radiologique, suture cutanée complexe, réduction de luxation ou gypsothérapie) et souvent à une hospitalisation. Le niveau de tri 3 représente habituellement 30 [10,19] voire 40 % des patients [20,21]. Il constitue un groupe très hétérogène par la variabilité des motifs de recours aux soins et surtout par la présence éventuelle de comorbidités (exemple : maladie chronique, patient très âgé, femme enceinte) qui rendent les situations plus complexes et les durées de prise en charge plus longues. ...
... Les valeurs de paramètres vitaux proposées par les experts de la CEQ et utilisées comme modulateurs pour définir le tri 1 sont : fréquence cardiaque (FC) supérieure à 180/minute ou inférieure ou égale à 40/minute, pression artérielle systolique (PAS) inférieure ou égale à 70 mmHg, fréquence respiratoire supérieure à 40/minute, score de Glasgow inférieur ou égal à 8 (Tableau 3). Les valeurs de paramètres vitaux utilisées comme modulateurs pour définir le tri 2 sont celles proposées dans la littérature pour le triage chez l'adulte : PAS inférieure ou égale à 90 mmHg [14,15], FC supérieure ou égale à 130/minute [14,15], shock index (FC/PAS > 1 si PAS entre 90 et 100 mmHg) [23], fréquence respiratoire supérieure ou égale à 30/minute [14,15], saturation en oxygène inférieure ou égale à 90 % [14,20], hypothermie inférieure ou égale à 35,2°C [17]. Les valeurs utilisées comme modulateurs pour définir le tri 3 sont intermédiaires entre celles qui définissent un tri 2 dans la littérature et les valeurs normales [14,15,20], d'autres sont proposées par les experts de la CEQ (PAS mesurée par l'IOA ≥ 180 mmHg sans signes fonctionnels associés ; FC : 40-50/minute sans mauvaise tolérance ; PAS : 90-100 mmHg et FC ≤ 100/minute). ...
... Les valeurs de paramètres vitaux utilisées comme modulateurs pour définir le tri 2 sont celles proposées dans la littérature pour le triage chez l'adulte : PAS inférieure ou égale à 90 mmHg [14,15], FC supérieure ou égale à 130/minute [14,15], shock index (FC/PAS > 1 si PAS entre 90 et 100 mmHg) [23], fréquence respiratoire supérieure ou égale à 30/minute [14,15], saturation en oxygène inférieure ou égale à 90 % [14,20], hypothermie inférieure ou égale à 35,2°C [17]. Les valeurs utilisées comme modulateurs pour définir le tri 3 sont intermédiaires entre celles qui définissent un tri 2 dans la littérature et les valeurs normales [14,15,20], d'autres sont proposées par les experts de la CEQ (PAS mesurée par l'IOA ≥ 180 mmHg sans signes fonctionnels associés ; FC : 40-50/minute sans mauvaise tolérance ; PAS : 90-100 mmHg et FC ≤ 100/minute). Les valeurs de paramètres vitaux associées à un mauvais pronostic chez l'enfant sont issues des recommandations internationales [24]. ...
La Société française de médecine d’urgence (SFMU) a recommandé la création d’une échelle spécifique, unique au niveau national, pour le triage des patients à l’accueil d’une structure d’urgences, prenant en compte les spécificités de l’adulte et de l’enfant. La commission de l’évaluation et de la qualité de la SFMU a créé, à l’instar des échelles de tri internationales, une échelle de tri avec cinq niveaux de priorité croissante (tris 5 à 1, du moins urgent au plus urgent) auxquels correspondent des motifs de recours aux soins de complexité/sévérité croissante. Le tri 3 a été subdivisé en deux groupes pour distinguer (et prioriser) les patients qui ont au moins une comorbidité en rapport avec le motif de recours aux soins ou qui sont adressés par un médecin (3A) des autres patients (3B). L’échelle de tri FRENCH (FRench Emergency Nurses Classification in Hospital) a donc six niveaux de priorité. À chaque niveau de tri correspondent des motifs de recours aux soins fréquents en médecine d’urgence, des modulateurs de tri, une répartition rationnelle des circuits patients et un délai maximum d’attente avant prise en charge médicale, après évaluation par l’infirmier(ière) d’accueil. Une première évaluation de la FRENCH a montré qu’elle répondait aux objectifs du triage en facilitant le repérage de l’urgence complexe/sévère de façon fiable et reproductible. De nouvelles évaluations sont nécessaires dans d’autres structures d’urgences pour confirmer sa performance et favoriser son évolution.
Background:
Hospitals from resource-scarce countries encounter significant barriers to the provision of injury care, particularly for children. Shortages in material and human resources are seldom documented, not least in African settings. This study analyzed pediatric injury care resources in Mozambique hospital settings.
Methods:
We undertook a cross-sectional study, encompassing the country's four largest hospitals. Data was collected in November 2020 at the pediatric emergency units. Assessment of the resources available was made with standardized WHO emergency equipment and medication checklists, and direct observation of premises and procedures. The potential impact of unavailable equipment and medications in pediatric wards was assessed considering the provisions of injury care.
Results:
There were significant amounts of not available equipment and medications in all hospitals (ranging from 20% to 49%) and two central hospitals stood out in that regard. The top categories of not available equipment pertained to diagnosis and monitoring, safety for health care personnel, and airway management. Medications to treat infections and poisonings were those most frequently not available. There were several noteworthy and life-threatening shortcomings in how well the facilities were equipped for treating pediatric patients. The staff regarded lack of equipment and skills as the main obstacles to delivering quality injury care. Further, they prioritized the implementation of trauma courses and the establishment of trauma centers to strengthen pediatric injury care.
Conclusion:
The country's four largest hospitals had substantial quality-care threatening shortages due to lack of equipment and medications for pediatric injury care. All four hospitals face issues that put at risk staff safety and impede the implementation of essential care interventions for injured children. Staff wishes for better training, working environments adequately equipped and well-organized. The room for improvement is considerable, the study results may help to set priorities, to benefit better outcomes in child injuries.
