Article Text

Download PDFPDF
Validation of the Taiwan triage and acuity scale: a new computerised five-level triage system
  1. Chip-Jin Ng1,
  2. Zui-Shen Yen2,
  3. Jeffrey Che-Hung Tsai3,
  4. Li Chin Chen4,
  5. Shou Ju Lin5,
  6. Yiing Yiing Sang6,
  7. Jih-Chang Chen1,
  8. TTAS national working group*
  1. 1Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
  2. 2Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
  3. 3Department of Emergency Medicine, Cheng Ching General Hospital, Taichung, Taiwan
  4. 4Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
  5. 5Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
  6. 6Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
  1. Correspondence to Dr Jih-Chang Chen, Department of Emergency Medicine, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Gueishan, Taoyuan 33333, Taiwan; a9999999{at}


Objective An ideal emergency department (ED) triage system accurately prioritises patients on the basis of the urgency of interventions required to avoid under- or over-triage. The objective of this study was to develop and validate a five-level Taiwan triage and acuity scale (TTAS) with an electronic decision support tool.

Methods This prospective, multicentre, observational study included 10533 patients triaged at 11 academic medical centres, 18 regional and four district hospitals. Adult patients presenting to the ED were independently triaged by the duty triage nurse in the usual way and trained research nurses using TTAS with a computerised decision support system. Weighted κ statistics were used to assess the reproducibility. Hospitalisation, length of stay, and medical resource consumption were analysed by TTAS acuity levels.

Results Most cases were stratified into levels 2 to 3 by the existing four-level triage system, whereas the TTAS stratified most patients to levels 3 (41.4%) and 4 (25.0%), and only a small number to level 1 (3.9%) (resuscitation; most urgent). Weighted κ for TTAS assignment was 0.87 (95% CI 0.85 to 0.89). The decrease in mean medical resource consumption and hospitalisation rate was statistically significant with each decrease in the TTAS triage acuity level. The length of stay also decreased significantly as the TTAS level acuity fell from levels 2 to 5.

Conclusions The TTAS was found to be a reliable triage system that accurately prioritises the treatment needed to avoid overtriage, more efficiently deploying the appropriate resources to ED patients.

  • Canadian triage acuity scale
  • clinical assessment
  • competence
  • five-level triage system
  • interobserver agreement
  • reliability
  • Taiwan triage and acuity scale
  • validity

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • * Includes representatives from the Taiwan Society of Emergency Medicine and Taiwan Association of Critical Care Nurses.

  • Funding This study was supported by a grant from the Taiwan Department of Health.

  • Competing interests None.

  • Ethics approval The study was conducted in accordance with the requirements and approval of the institutional review boards of all the participating hospitals.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • Primary survey
    Malcolm Woollard