Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 4/2020

19.11.2018 | Original Article

Validity of the Korean Triage and Acuity Scale for predicting 30-day mortality due to severe trauma: a retrospective single-center study

verfasst von: Yong Deok Lim, Dong Hun Lee, Byung Kook Lee, Yong Soo Cho, Goeun Choi

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Since January 2016, emergency medical centers in South Korea have used the Korean Triage and Acuity Scale (KTAS) as the initial triage tool for all patients, including trauma patients, who visited the emergency department (ED). This present study aimed to assess the validity of the KTAS for predicting 30-day mortality due to severe trauma.

Methods

This retrospective study included patients with severe trauma (injury severity score ≥ 16) from January 2016 to December 2017. Using KTAS, all patients were triaged as levels 1, 2, 3, and 4 by triage nurses. The primary outcome was 30-day mortality, and the secondary outcome was disposition at the ED. Disposition at the ED included admission to the general ward, intensive care unit, or operation room or death in the ED.

Results

Of the 827 included patients, 30-day mortality was observed in 14.9% (n = 123) of patients. Mortality was observed in 52.5% (n = 42), 15.5% (n = 69), 4.1% (n = 12), and 0.0% (n = 0) of patients in levels 1, 2, 3, and 4, respectively. The Cox proportional hazard regression analysis showed that compared to level 3, level 1 [hazard ratio (HR) 4.868; 95% confidence interval (CI) 2.341–10.119] and level 2 (HR 2.070; 95% CI 1.083–3.956) were independently associated with 30-day mortality. Patients with lower KTAS levels were more likely to be admitted to the operation room and were more likely to die in the ED.

Conclusion

Lower KTAS levels were associated with higher 30-day mortality due to severe trauma. KTAS shows adequate validity for predicting 30-day mortality from severe trauma.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat McCarthy ML, Zeger SL, Ding R, et al. Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Ann Emerg Med. 2009;54:492–503.CrossRef McCarthy ML, Zeger SL, Ding R, et al. Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Ann Emerg Med. 2009;54:492–503.CrossRef
2.
Zurück zum Zitat Pines JM, Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:1–5.CrossRef Pines JM, Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:1–5.CrossRef
3.
Zurück zum Zitat McCaig LF, Newar EW. National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. Adv Data. 2006;(372):1–29. McCaig LF, Newar EW. National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. Adv Data. 2006;(372):1–29.
4.
Zurück zum Zitat Hardern RD. Critical appraisal of papers describing triage systems. Acad Emerg Med. 1999;6:1166–71.CrossRef Hardern RD. Critical appraisal of papers describing triage systems. Acad Emerg Med. 1999;6:1166–71.CrossRef
5.
Zurück zum Zitat Lee B, Kim DK, Park JD, Kwak YH. Clinical considerations when applying vital signs in pediatric Korean Triage and Acuity Scale. J Korean Med Sci. 2017;32:1702–7.CrossRef Lee B, Kim DK, Park JD, Kwak YH. Clinical considerations when applying vital signs in pediatric Korean Triage and Acuity Scale. J Korean Med Sci. 2017;32:1702–7.CrossRef
6.
Zurück zum Zitat Lefering R, Paffrath T, Bouamra O, et al. Epidemiology of in-hospital trauma death. Eur J Trauma Emerg Surg. 2012;38:3–9.CrossRef Lefering R, Paffrath T, Bouamra O, et al. Epidemiology of in-hospital trauma death. Eur J Trauma Emerg Surg. 2012;38:3–9.CrossRef
7.
Zurück zum Zitat Porter A, Karim S, Bowman SM, Recicar J, Bledsoe GH, Maxson RT. Impact of a statewide trauma system on the triage, transfer, and inpatient mortality of injured patients. J Trauma Acute Care Surg. 2018;84:771–9.CrossRef Porter A, Karim S, Bowman SM, Recicar J, Bledsoe GH, Maxson RT. Impact of a statewide trauma system on the triage, transfer, and inpatient mortality of injured patients. J Trauma Acute Care Surg. 2018;84:771–9.CrossRef
8.
Zurück zum Zitat Miller RT, Nazir N, McDonald T, Cannon CM. The modified rapid emergency medicine score: a novel trauma triage tool to predict in-hospital mortality. Injury. 2017;48:1870–7.CrossRef Miller RT, Nazir N, McDonald T, Cannon CM. The modified rapid emergency medicine score: a novel trauma triage tool to predict in-hospital mortality. Injury. 2017;48:1870–7.CrossRef
9.
Zurück zum Zitat Cannon CM, Braxton CC, Kling-Smith M, Mahnken JD, Carlton E, Moncure M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma. 2009;67:1426–30.CrossRef Cannon CM, Braxton CC, Kling-Smith M, Mahnken JD, Carlton E, Moncure M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma. 2009;67:1426–30.CrossRef
10.
Zurück zum Zitat Yates MT, Ishikawa T, Schneeberg A, Brussoni M. Pediatric Canadian Triage and Acuity Scale (PaedsCTAS) as a measure of injury severity. Int J Environ Res Public Health. 2016;13:E659.CrossRef Yates MT, Ishikawa T, Schneeberg A, Brussoni M. Pediatric Canadian Triage and Acuity Scale (PaedsCTAS) as a measure of injury severity. Int J Environ Res Public Health. 2016;13:E659.CrossRef
11.
Zurück zum Zitat Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluation emergency care. J Trauma. 1974;14:187–96.CrossRef Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluation emergency care. J Trauma. 1974;14:187–96.CrossRef
12.
Zurück zum Zitat Skaga NO, Eken T, Jones JM, Steen PA. Different definitions of patient outcome: consequences for performance analysis in trauma. Injury. 2008;39:612–22.CrossRef Skaga NO, Eken T, Jones JM, Steen PA. Different definitions of patient outcome: consequences for performance analysis in trauma. Injury. 2008;39:612–22.CrossRef
13.
Zurück zum Zitat Kuo SCH, Kuo PJ, Chen YC, Chien PC, Hsieh HY, Hsieh CH. Comparison of the new exponential injury severity score with the injury severity score and the new injury severity score in trauma patients: a cross-sectional study. PLoS One. 2017;12:e0187871.CrossRef Kuo SCH, Kuo PJ, Chen YC, Chien PC, Hsieh HY, Hsieh CH. Comparison of the new exponential injury severity score with the injury severity score and the new injury severity score in trauma patients: a cross-sectional study. PLoS One. 2017;12:e0187871.CrossRef
14.
Zurück zum Zitat Birkhahn RH, Gaeta TJ, Terry D, Bove JJ, Tloczkowski J. Shock index in diagnosing early acute hypovolemia. Am J Emerg Med. 2005;23:323–6.CrossRef Birkhahn RH, Gaeta TJ, Terry D, Bove JJ, Tloczkowski J. Shock index in diagnosing early acute hypovolemia. Am J Emerg Med. 2005;23:323–6.CrossRef
15.
Zurück zum Zitat Mutschler M, Nienaber U, Münzberg M, et al. The Shock Index revisited—a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the Trauma Register DGU. Crit Care Lond Engl. 2013;17:R172.CrossRef Mutschler M, Nienaber U, Münzberg M, et al. The Shock Index revisited—a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the Trauma Register DGU. Crit Care Lond Engl. 2013;17:R172.CrossRef
16.
Zurück zum Zitat El-Menyar A, Goyal P, Tilley E, Latifi R. The clinical utility of shock index to predict the need for blood transfusion and outcomes in trauma. J Surg Res. 2018;227:52–9.CrossRef El-Menyar A, Goyal P, Tilley E, Latifi R. The clinical utility of shock index to predict the need for blood transfusion and outcomes in trauma. J Surg Res. 2018;227:52–9.CrossRef
17.
Zurück zum Zitat Kuriyama A, Ikegami T, Kaihara T, Fukuoka T, Nakayama T. Validity of the Japan Acuity and Triage Scale in adults: a cohort study. Emerg Med J. 2018;35:384–8.CrossRef Kuriyama A, Ikegami T, Kaihara T, Fukuoka T, Nakayama T. Validity of the Japan Acuity and Triage Scale in adults: a cohort study. Emerg Med J. 2018;35:384–8.CrossRef
18.
Zurück zum Zitat Lee JY, Oh SH, Peck EH, et al. The validity of the Canadian Triage and Acuity Scale in predicting resource utilization and the need for immediate life-saving interventions in elderly emergency department patients. Scand J Trauma Resusc Emerg Med. 2011;19:68.CrossRef Lee JY, Oh SH, Peck EH, et al. The validity of the Canadian Triage and Acuity Scale in predicting resource utilization and the need for immediate life-saving interventions in elderly emergency department patients. Scand J Trauma Resusc Emerg Med. 2011;19:68.CrossRef
19.
Zurück zum Zitat Miller J, Lieberman L, Nahab B, et al. Delayed intracranial hemorrhage in the anticoagulated patient: a systematic review. J Trauma Acute Care Surg. 2015;79:310–3.CrossRef Miller J, Lieberman L, Nahab B, et al. Delayed intracranial hemorrhage in the anticoagulated patient: a systematic review. J Trauma Acute Care Surg. 2015;79:310–3.CrossRef
20.
Zurück zum Zitat Goettler CE, Stallion A, Grisoni ER, Dudgeon DL. Delayed hemorrhage after blunt hepatic trauma: case report. J Trauma. 2002;52:556–9.PubMed Goettler CE, Stallion A, Grisoni ER, Dudgeon DL. Delayed hemorrhage after blunt hepatic trauma: case report. J Trauma. 2002;52:556–9.PubMed
21.
Zurück zum Zitat Evrimler S, Okumuser I, Delibas D. Delayed small bowel perforation with findings of severe ischemia following blunt abdominal trauma. Pol J Radiol. 2017;82:271–4.CrossRef Evrimler S, Okumuser I, Delibas D. Delayed small bowel perforation with findings of severe ischemia following blunt abdominal trauma. Pol J Radiol. 2017;82:271–4.CrossRef
22.
Zurück zum Zitat Chang SW, Ryu KM, Ryu JW. Delayed massive hemothorax requiring surgery after blunt thoracic trauma over a 5-year period: complicating rib fracture with sharp edge associated with diaphragm injury. Clin Exp Emerg Med. 2018;5:60–5.CrossRef Chang SW, Ryu KM, Ryu JW. Delayed massive hemothorax requiring surgery after blunt thoracic trauma over a 5-year period: complicating rib fracture with sharp edge associated with diaphragm injury. Clin Exp Emerg Med. 2018;5:60–5.CrossRef
23.
Zurück zum Zitat 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;5:315–22.PubMed 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;5:315–22.PubMed
24.
Zurück zum Zitat Rainer TH, Ho AM, Yeung JH, et al. Early risk stratification of patients with major trauma requiring massive blood transfusion. Resuscitation. 2011;82:724–9.CrossRef Rainer TH, Ho AM, Yeung JH, et al. Early risk stratification of patients with major trauma requiring massive blood transfusion. Resuscitation. 2011;82:724–9.CrossRef
25.
Zurück zum Zitat Sawamura A, Hayakawa M, Gando S, et al. Disseminated intravascular coagulation with a fibrinolytic phenotype at an early phase of trauma predicts mortality. Thromb Res. 2009;124:608–13.CrossRef Sawamura A, Hayakawa M, Gando S, et al. Disseminated intravascular coagulation with a fibrinolytic phenotype at an early phase of trauma predicts mortality. Thromb Res. 2009;124:608–13.CrossRef
Metadaten
Titel
Validity of the Korean Triage and Acuity Scale for predicting 30-day mortality due to severe trauma: a retrospective single-center study
verfasst von
Yong Deok Lim
Dong Hun Lee
Byung Kook Lee
Yong Soo Cho
Goeun Choi
Publikationsdatum
19.11.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 4/2020
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-018-1048-y

Weitere Artikel der Ausgabe 4/2020

European Journal of Trauma and Emergency Surgery 4/2020 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.