The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study
Authors:
Belinda De Simone, Yoram Kluger, Ernest E. Moore, Massimo Sartelli, Fikri M. Abu-Zidan, Federico Coccolini, Luca Ansaloni, Giovanni D. Tebala, Salomone Di Saverio, Isidoro Di Carlo, Boris E. Sakakushev, Luigi Bonavina, Michael Sugrue, Joseph M. Galante, Rao Ivatury, Edoardo Picetti, Mircea Chirica, Imtiaz Wani, Miklosh Bala, Ibrahima Sall, Andrew W. Kirkpatrick, Vishal G. Shelat, Emmanouil Pikoulis, Ari Leppäniemi, Edward Tan, Richard P. G. ten Broek, Solomon Gurmu Beka, Andrey Litvin, Elie Chouillard, Raul Coimbra, Yunfeng Cui, Nicola De’ Angelis, Gabriele Sganga, Philip F. Stahel, Vanni Agnoletti, Alessia Rampini, Mario Testini, Francesca Bravi, Ronald V. Maier, Walter L. Biffl, Fausto Catena, WSES TACS panel of experts
Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The “timing in acute care surgery” (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts.
Methods
This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4–5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease.
Results
Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority.
Conclusion
The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a “safe” timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients.
The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study
Authors
Belinda De Simone Yoram Kluger Ernest E. Moore Massimo Sartelli Fikri M. Abu-Zidan Federico Coccolini Luca Ansaloni Giovanni D. Tebala Salomone Di Saverio Isidoro Di Carlo Boris E. Sakakushev Luigi Bonavina Michael Sugrue Joseph M. Galante Rao Ivatury Edoardo Picetti Mircea Chirica Imtiaz Wani Miklosh Bala Ibrahima Sall Andrew W. Kirkpatrick Vishal G. Shelat Emmanouil Pikoulis Ari Leppäniemi Edward Tan Richard P. G. ten Broek Solomon Gurmu Beka Andrey Litvin Elie Chouillard Raul Coimbra Yunfeng Cui Nicola De’ Angelis Gabriele Sganga Philip F. Stahel Vanni Agnoletti Alessia Rampini Mario Testini Francesca Bravi Ronald V. Maier Walter L. Biffl Fausto Catena WSES TACS panel of experts