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Validity of the Taiwan Triage and Acuity Scale in mainland China: a retrospective observational study
  1. Qing-Qing Chen1,2,
  2. Sherry Yueh-Hsia Chiu3,4,
  3. Lai-Yin Tsai2,
  4. Rong-Fang Hu1
  1. 1School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
  2. 2Nursing Department, Xiamen Chang Gung Hospital, Xiamen, China
  3. 3Department of Health Care Management, Chang Gung University College of Management, Taoyuan, Taiwan
  4. 4Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
  1. Correspondence to Rong-Fang Hu, School of Nursing, Fujian Medical University, Fuzhou, Fujian 350122, China; hulu2886{at}sina.com

Abstract

Objectives The Taiwan Triage and Acuity Scale (TTAS), developed for use in EDs, has been shown to be an excellent tool for triaging patients with high predictive performance, with an area under the receiver operating curve (AUROC) of 0.75. TTAS has been widely used in hospitals in Taiwan since 2010, but its utility has not been studied outside of Taiwan. Thus, the aim of this study was to evaluate the validity of using the TTAS in the ED of a tertiary hospital in mainland China to predict patient outcomes.

Methods A retrospective observational study was performed on patients 14 years of age or older attending the ED of a tertiary hospital in mainland China between 1 January 2016 and 31 March 2016. The validity of the TTAS in predicting hospital admission, intensive care unit (ICU) admission, death, ED length of stay (LOS) and ED resource utilisation was evaluated by determining the correlation of these outcomes with the TTAS, AUROC and test characteristics.

Results A total of 7843 patients were included in this study. There were significant differences between the TTAS categories in disposition, ED LOS and ED resource utilisation (p<0.0001). The TTAS was significantly correlated with patient disposition at discharge, hospital admission, ICU admission and death in the ED (Kendall rank correlations were 0.254, –0.254, −0.079 and −0.071, respectively; p=0.001). The AUROCs for the prediction of hospital admissions, ICU admissions and deaths in the ED were 0.749 (95% CI 0.732 to 0.765), 0.869 (95% CI 0.797 to 0.942) and 0.998 (95% CI 0.995 to 1.000), respectively. Our results demonstrated better performance using the TTAS for predictions of ICU admission and death.

Conclusions The TTAS had good validity in predicting patient outcomes and ED resource utilisation in a tertiary hospital in mainland China. Compared with the performance of the TTAS in Taiwan, our results suggest that the TTAS can usefully be applied outside of Taiwan.

  • emergency department
  • triage

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (Rong-fang Hu), upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (Rong-fang Hu), upon reasonable request.

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Footnotes

  • Handling editor Kirsty Challen

  • Contributors All of the authors participated in designing the study. Q-QC collected and analysed the data and wrote the first draft of the manuscript. SY-HC analysed and revised the manuscript. L-YT supported administration of the study. R-FH supervised the conduct of the study and made revisions. All of the authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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