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Triage category and prediction of longer-term outcomes
Triage identifies patients who require the most urgent attention, and allows stratification of scarce resources. Many emergency presentations conceal a multitude of sins, with few as all-encompassing as syncope. The broad range of conditions that provoke, mimic or originate as syncope means that predicting those most risk in this broad group relies on exhaustive and penetrating questioning and examination.
Bonzi's retrospective study on 678 syncope patients found that the triage process was poorly predictive of adverse events at 10 days. They also examined an OESIL score, and found that previous cardiac history and abnormal ECG were predictive of later disasters. This paper highlights that triage, for all its uses in managing flow in an ED, is no substitute for early, informed, careful risk-stratification, and that it will not perform well in an area for which it was never designed.
Traumatic head injury triage
A cohort study by Fuller et al from TARN investigated the classification of adult head injury patients by the London Ambulance Service (LAS) and the Head Injury Transportation Straight to Neurosurgery (HITS-NS) criteria.
Bypass of major trauma patients to definitive care is a common …