A prospective evaluation of the Cape triage score in the emergency department of an urban public hospital in South Africa

Abstract

Background: Until recently South Africa had no triage system for emergency department (ED) use. The Cape triage group developed a triage scale called the Cape triage score (CTS). This system consists of a basic physiology score, mobility score and a short list of important discriminators that cannot be accurately triaged on a physiological score alone. Highest priority is given to a red colour code, followed by orange, yellow and green.

Aim: The purpose was to evaluate the components of the CTS and identify amendments that would improve the quality of the scale in terms of its accuracy to identify patients more likely to require admission or at high risk of death in the ED.

Methods: Data were prospectively collected over a 4-month period. Data captured included the parameters of a basic physiological score (respiratory rate, pulse rate, systolic blood pressure, temperature and a simplified score measuring level of consciousness), mobility, a list of selected clinical conditions (discriminator list), final clinical diagnosis and final outcome in the ED (admission to hospital or death).

Results: 798 patients were triaged and analyzed. The CTS undertriaged 24% (overtriage 25%) of cases who required admission. By altering the colour code parameters, amending the discriminator list as well as the addition of a trauma factor, undertriage was reduced to 12% (with an overtriage of 45%).

Conclusions: The amended CTS has an acceptably low undertriage rate and is capable of predicting patient disposal over a wide spectrum of ED presentations.