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Comparison of prehospital triage and five-level triage system at the emergency department
  1. Li-Heng Tsai1,
  2. Chien-Hsiung Huang2,4,
  3. Yi-Chia Su1,
  4. Yi-Ming Weng1,
  5. Chung-Hsien Chaou1,
  6. Wen-Cheng Li3,
  7. Chan-Wei Kuo1,
  8. Chip-Jin Ng1
  1. 1 Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
  2. 2 Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
  3. 3 Department of Occupation Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
  4. 4 Department of Emergency Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
  1. Correspondence to Dr Chip-Jin Ng, Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 5 Fushing St., Gueishan Shiang, Taoyuan, Taiwan; zabrina0316{at}


Objective There is lack of scientific evidence regarding the effectiveness of prehospital triage systems. This study compared the two-level Taiwan Prehospital Triage System (TPTS) with the five-level Taiwan Triage and Acuity Scale (TTAS) at ED arrival regarding the prediction of patient outcomes and the utilisation of medical resources.

Design This was a retrospective cohort study. Adult patients transported via the emergency medical service (EMS), who arrived at the ED of a medical centre in northern Taiwan during the study period were enrolled. TTAS acuity levels 1–2 were considered comparable to the designation of ‘emergent’ by the prehospital TPTS system. The outcomes were analysed by comparing TPTS and TTAS by acuity levels.

Results Among 4430 enrolled patients, 25.2% and 74.8% were classified as emergent and non-emergent by TPTS; 44.1% and 55.9% were classified as levels 1–2 and levels 3–5 by TTAS. Of the TPTS emergent patients, 15.2% were classified as TTAS levels 3–5, whereas 30.4% of TPTS non-emergent transports were classified as TTAS levels 1–2 at the ED. TTAS levels 1–2 showed better predictability than TPTS emergent level for hospitalisation rate with a sensitivity of 70.3% (95% CI 68.3% to 72.2%) versus 41.1% (95% CI 39.0% to 43.2%), and a negative predictive value of 74.8% (95% CI 73.4% to 76.0%) versus 62.6% (95% CI 61.7% to 63.5%).

Conclusion The current prehospital triage system is insufficient and inappropriate in classifying patients transported to the ED. The present study offers supporting evidence for the introduction of a five-level triage system to prehospital EMS systems.

  • emergency care systems
  • pre-hospital
  • triage, emergency departments
  • emergency ambulance systems, effectiveness

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  • Contributors All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published. C-JN had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. L-HT and C-HH carried out analysis and interpretation of the data, drafting of the manuscript and acquisition of the data. Y-CS conceived the study, participated in its design and coordination and helped to draft the manuscript. Y-MW and C-HC performed the statistical analysis and given technical or material support. C-WK participated in the material support and obtained funding. W-CL participated in acquisition of the data.

  • Funding This study is also indebted to grant funding from the Ministry of Science and Technology, Taiwan (Fund No. NMRPG3d0181).

  • Competing interests None declared.

  • Ethics approval Ethics approval was provided by the Ethics on Human Research of the Chang Gung Medical Foundation.

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

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