The Copenhagen Triage Algorithm is non-inferior to a traditional triage algorithm: A cluster-randomized study

PLoS One. 2019 Feb 4;14(2):e0211769. doi: 10.1371/journal.pone.0211769. eCollection 2019.

Abstract

Introduction: Triage systems with limited room for clinical judgment are used by emergency departments (EDs) worldwide. The Copenhagen Triage Algorithm (CTA) is a simplified triage system with a clinical assessment.

Methods: The trial was a non-inferiority, two-center cluster-randomized crossover study where CTA was compared to a local adaptation of Adaptive Process Triage (ADAPT). CTA involves initial categorization based on vital signs with a final modification based on clinical assessment by an ED nurse. We used 30-day mortality with a non-inferiority margin at 0.5%. Predictive performance was compared using Receiver Operator Characteristics.

Results: We included 45,347 patient visits, 23,158 (51%) and 22,189 (49%) were triaged with CTA and ADAPT respectively with a 30-day mortality of 3.42% and 3.43% (P = 0.996) a difference of 0.01% (95% CI: -0.34 to 0.33), which met the non-inferiority criteria. Mortality at 48 hours was 0.62% vs. 0.71%, (P = 0.26) and 6.38% vs. 6.61%, (P = 0.32) at 90 days for CTA and ADAPT. CTA triaged at significantly lower urgency level (P<0.001) and was superior in predicting 30-day mortality, Area under the curve: 0.67 (95% CI 0.65-0.69) compared to 0.64 for ADAPT (95% CI 0.62-0.66) (P = 0.03). There were no significant differences in rate of admission to the intensive care unit, length of stay, waiting time nor rate of readmission within 30 or 90 days.

Conclusion: A novel triage system based on vital signs and a clinical assessment by an ED nurse was non-inferior to a traditional triage algorithm by short term mortality, and superior in predicting 30-day mortality.

Trial registration: Clinicaltrials.gov NCT02698319.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms*
  • Cross-Over Studies
  • Denmark
  • Emergency Service, Hospital*
  • Female
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Time Factors
  • Triage*

Associated data

  • ClinicalTrials.gov/NCT02698319

Grants and funding

This work was supported by TrygFonden (ID 114472), https://www.trygfonden.dk. Funding was received by KI. Role of funding source: The study is funded by TrygFonden. The trial is driven and initiated by the researchers and the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.