RT Journal Article
SR Electronic
T1 Predicting admission at triage: are nurses better than a simple objective score?
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 2
OP 7
DO 10.1136/emermed-2014-204455
VO 34
IS 1
A1 Allan Cameron
A1 Alastair J Ireland
A1 Gerard A McKay
A1 Adam Stark
A1 David J Lowe
YR 2017
UL http://emj.bmj.com/content/34/1/2.abstract
AB Aim We compared two methods of predicting hospital admission from ED triage: probabilities estimated by triage nurses and probabilities calculated by the Glasgow Admission Prediction Score (GAPS).Methods In this single-centre prospective study, triage nurses estimated the probability of admission using a 100 mm visual analogue scale (VAS), and GAPS was generated automatically from triage data. We compared calibration using rank sum tests, discrimination using area under receiver operating characteristic curves (AUC) and accuracy with McNemar's test.Results Of 1829 attendances, 745 (40.7%) were admitted, not significantly different from GAPS’ prediction of 750 (41.0%, p=0.678). In contrast, the nurses’ mean VAS predicted 865 admissions (47.3%), overestimating by 6.6% (p<0.0001). GAPS discriminated between admission and discharge as well as nurses, its AUC 0.876 compared with 0.875 for VAS (p=0.93). As a binary predictor, its accuracy was 80.6%, again comparable with VAS (79.0%), p=0.18. In the minority of attendances, when nurses felt at least 95% certain of the outcome, VAS’ accuracy was excellent, at 92.4%. However, in the remaining majority, GAPS significantly outperformed VAS on calibration (+1.2% vs +9.2%, p<0.0001), discrimination (AUC 0.810 vs 0.759, p=0.001) and accuracy (75.1% vs 68.9%, p=0.0009). When we used GAPS, but ‘over-ruled’ it when clinical certainty was ≥95%, this significantly outperformed either method, with AUC 0.891 (0.877–0.907) and accuracy 82.5% (80.7%–84.2%).Conclusions GAPS, a simple clinical score, is a better predictor of admission than triage nurses, unless the nurse is sure about the outcome, in which case their clinical judgement should be respected.