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Predictors of admission to hospital of patients triaged as nonurgent using the Canadian Triage and Acuity Scale

Published online by Cambridge University Press:  04 March 2015

Daren Lin  and
Andrew Worster
Daren Lin*
Affiliation:
Division of Emergency Medicine, McMaster University, Hamilton, ON
Andrew Worster
Affiliation:
Division of Emergency Medicine, McMaster University, Hamilton, ON
*
Division of Emergency Medicine, McMaster University, 237 Barton Street East, Hamilton, ONL8L 2X2; [email protected].

Abstract

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Objectives:

To identify factors known prior to triage that might have predicted hospital admission for patients triaged by the Canadian Triage Acuity Scale (CTAS) as level 5 (CTAS 5, nonurgent) and to determine whether inappropriate triage occurred in the admitted CTAS 5 patients.

Methods:

We reviewed the triage records of patients triaged as CTAS 5 at the emergency departments (EDs) of three tertiary care hospitals between April 2002 and September 2009. Two triage nurses unaware of the study objective independently assigned the CTAS level in 20% of randomly selected CTAS 5 patients who were admitted. We used the kappa statistic (κ) to measure the agreement among the raters in CTAS level between the assessment of the research nurses and the original triage assessment and regression analysis to identify independent predictors of admission to hospital.

Results:

Of the 37,416 CTAS 5 patients included in this study, 587 (1.6%) were admitted. Agreement on CTAS assignment in CTAS 5 patients who were admitted was κ −0.9, (95% confidence interval [CI] 20.96 to 20.84). Age over 65 (odds ratio [OR] 5.46, 95% CI 4.57 to 6.53) and arrival by ambulance (OR 7.42, 95% CI 6.15 to 8.96) predicted hospital admission in CTAS 5 patients.

Conclusions:

Most of the CTAS 5 patients who were subsequently admitted to hospital may have qualified for a higher triage category. Two potential modifiers, age over 65 and arrival by ambulance, may have improved the prediction of admission in CTAS 5 patients. However, the consistent application of existing CTAS criteria may also be important to prevent incorrect triage.

Keywords

admissionCanadian Triage and Acuity Scaleinterrater reliability
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 6 , November 2013 , pp. 353 - 358
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

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