Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016

Open Access 01-12-2016 | Study protocol

The Copenhagen Triage Algorithm: a randomized controlled trial

Authors: Rasmus Bo Hasselbalch, Louis Lind Plesner, Mia Pries-Heje, Lisbet Ravn, Morten Lind, Rasmus Greibe, Birgitte Nybo Jensen, Lars S. Rasmussen, Kasper Iversen

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2016

Login to get access

Abstract

Background

Crowding in the emergency department (ED) is a well-known problem resulting in an increased risk of adverse outcomes. Effective triage might counteract this problem by identifying the sickest patients and ensuring early treatment. In the last two decades, systematic triage has become the standard in ED’s worldwide. However, triage models are also time consuming, supported by limited evidence and could potentially be of more harm than benefit. The aim of this study is to develop a quicker triage model using data from a large cohort of unselected ED patients and evaluate if this new model is non-inferior to an existing triage model in a prospective randomized trial.

Methods

The Copenhagen Triage Algorithm (CTA) study is a prospective two-center, cluster-randomized, cross-over, non-inferiority trial comparing CTA to the Danish Emergency Process Triage (DEPT). We include patients ≥16 years (n = 50.000) admitted to the ED in two large acute hospitals. Centers are randomly assigned to perform either CTA or DEPT triage first and then use the other triage model in the last time period. The CTA stratifies patients into 5 acuity levels in two steps. First, a scoring chart based on vital values is used to classify patients in an immediate category. Second, a clinical assessment by the ED nurse can alter the result suggested by the score up to two categories up or one down. The primary end-point is 30-day mortality and secondary end-points are length of stay, time to treatment, admission to intensive care unit, and readmission within 30 days.

Discussion

If proven non-inferior to standard DEPT triage, CTA will be a faster and simpler triage model that is still able to detect the critically ill. Simplifying triage will lessen the burden for the ED staff and possibly allow faster treatment.

Trial registration

Clinicaltrials.gov: NCT02698319, registered 24. of February 2016, retrospectively registered
Literature
1.
Carter EJ, Pouch SM, Larson EL. The relationship between emergency department crowding and patient outcomes: a systematic review. J Nurs Sch. 2014;46(2):106–15.CrossRef
2.
FitzGerald G, Jelinek GA, Scott D, Gerdtz MF. Emergency department triage revisited. Emerg Med J. 2010;27(2):86–92.CrossRefPubMed
3.
Weyrich P, Christ M, Celebi N, Riessen R. Triage systems in the emergency department. Med Klin Intensivmed Notfallmed. 2012;107(1):67–78. quiz 9.CrossRef
4.
Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Acad Emerg Med. 2000;7(3):236–42.CrossRefPubMed
5.
Moll HA. Challenges in the validation of triage systems at emergency departments. J Clin Epidemiol. 2010;63(4):384–8.CrossRefPubMed
6.
Graff I, Goldschmidt B, Glien P, Bogdanow M, Fimmers R, Hoeft A, et al. The German Version of the Manchester Triage System and its quality criteria--first assessment of validity and reliability. PLoS One. 2014;9(2):e88995.CrossRefPubMedPubMedCentral
7.
Bruijns SR, Wallis LA, Burch VC. A prospective evaluation of the Cape triage score in the emergency department of an urban public hospital in South Africa. Emerg Med J. 2008;25(7):398–402.CrossRefPubMed
8.
Jobe J, Ghuysen A, Gerard P, Hartstein G, D’Orio V. Reliability and validity of a new French-language triage algorithm: the ELISA scale. Emerg Med J. 2014;31(2):115–20.CrossRefPubMed
9.
Taboulet P, Moreira V, Haas L, Porcher R, Braganca A, Fontaine JP, et al. Triage with the French Emergency Nurses Classification in Hospital scale: reliability and validity. Eur J Emerg Med. 2009;16(2):61–7.CrossRefPubMed
10.
Farrokhnia N, Goransson KE. Swedish emergency department triage and interventions for improved patient flows: a national update. Scand J Trauma Resusc Emerg Med. 2011;19:72.CrossRefPubMedPubMedCentral
11.
Skriver C, Lauritzen MM, Forberg JL, Gaardboe-Poulsen OB, Mogensen CB, Hansen CL, et al. Triage quickens the treatment of the most sick patients. Ugeskr Laeger. 2011;173(40):2490–3.PubMed
12.
Iversen AK, Kristensen M, Ostervig R, Forberg JL, Schou M, Iversen K. [No evidence that formalized triage is superior to informally structured triage]. Ugeskr Laeger. 2015;177(30):2–6.
13.
Johansen MB, Forberg JL. Nurses’ evaluation of a new formalized triage system in the emergency department - a qualitative study. Dan Med Bull. 2011;58(10):A4311.PubMed
14.
15.
Farrohknia N, Castren M, Ehrenberg A, Lind L, Oredsson S, Jonsson H, et al. Emergency department triage scales and their components: a systematic review of the scientific evidence. Scand J Trauma Resusc Emerg Med. 2011;19:42.CrossRefPubMedPubMedCentral
16.
17.
JMurray M. The Canadian Triage and Acuity Scale: A Canadian perspective on emergency department triage. Emerg Med (Fremantle). 2003;15(1):6–10.CrossRef
18.
Hardern RD. Critical appraisal of papers describing triage systems. Acad Emerg Med. 1999;6(11):1166–71.CrossRefPubMed
19.
Eitel DR, Travers DA, Rosenau AM, Gilboy N, Wuerz RC. The emergency severity index triage algorithm version 2 is reliable and valid. Acad Emerg Med. 2003;10(10):1070–80.CrossRefPubMed
20.
Tanabe P, Gimbel R, Yarnold PR, Adams JG. The Emergency Severity Index (version 3) 5-level triage system scores predict ED resource consumption. J Emerg Nurs. 2004;30(1):22–9.CrossRefPubMed
21.
Barfod C, Lauritzen MM, Danker JK, Soletormos G, Forberg JL, Berlac PA, et al. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2012;20:28.CrossRefPubMedPubMedCentral
22.
Doherty SR, Hore CT, Curran SW. Inpatient mortality as related to triage category in three New South Wales regional base hospitals. Emerg Med (Fremantle). 2003;15(4):334–40.CrossRef
23.
Martins HM, Cuna LM, Freitas P. Is Manchester (MTS) more than a triage system? A study of its association with mortality and admission to a large Portuguese hospital. Emerg Med J. 2009;26(3):183–6.CrossRefPubMed
24.
Plesner LL, Iversen AK, Langkjaer S, Nielsen TL, Ostervig R, Warming PE, et al. The formation and design of the TRIAGE study--baseline data on 6005 consecutive patients admitted to hospital from the emergency department. Scand J Trauma Resusc Emerg Med. 2015;23:106.CrossRefPubMedPubMedCentral
25.
Iversen AK S, Forberg JL, Schou M, Rasmussen LS, Køber L, Iversen K. Comparison of systematic triage with clinical assessment in prediction of short-term mortality. Scand J Trauma Resusc Emerg Med. 2015;23(1):1.CrossRef
26.
27.
28.
Barfod C, Lauritzen MM, Danker JK, Soletormos G, Berlac PA, Lippert F, et al. The formation and design of the ‘Acute Admission Database’- a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital. Scand J Trauma Resusc Emerg Med. 2012;20:29.CrossRefPubMedPubMedCentral
29.
Blunt I, Bardsley M, Grove A, Clarke A. Classifying emergency 30-day readmissions in England using routine hospital data 2004-2010: what is the scope for reduction? Emerg Med J. 2015;32(1):44–50.CrossRefPubMed
30.
Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126–36.CrossRefPubMed
31.
Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 2006;184(5):213–6.PubMed
32.
Christensen D, Jensen NM, Maaloe R, Rudolph SS, Belhage B, Perrild H. Nurse-administered early warning score system can be used for emergency department triage. Dan Med Bull. 2011;58(6):A4221.PubMed
33.
Subbe CP, Slater A, Menon D, Gemmell L. Validation of physiological scoring systems in the accident and emergency department. Emerg Med J. 2006;23(11):841–5.CrossRefPubMedPubMedCentral
34.
Considine J, LeVasseur SA, Villanueva E. The Australasian Triage Scale: examining emergency department nurses’ performance using computer and paper scenarios. Ann Emerg Med. 2004;44(5):516–23.CrossRefPubMed
35.
36.
Lyngbaek S, Andersson C, Marott JL, Moller DV, Christiansen M, Iversen KK, et al. Soluble urokinase plasminogen activator receptor for risk prediction in patients admitted with acute chest pain. Clin Chem. 2013;59(11):1621–9.CrossRefPubMed
37.
Seymour CW, Cooke CR, Wang Z, Kerr KF, Yealy DM, Angus DC, et al. Improving risk classification of critical illness with biomarkers: A simulation study. J Crit Care. 2013;28(5):541–48.
Metadata
Title
The Copenhagen Triage Algorithm: a randomized controlled trial
Authors
Rasmus Bo Hasselbalch
Louis Lind Plesner
Mia Pries-Heje
Lisbet Ravn
Morten Lind
Rasmus Greibe
Birgitte Nybo Jensen
Lars S. Rasmussen
Kasper Iversen
Publication date
01-12-2016
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-016-0312-6

Other articles of this Issue 1/2016

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016 Go to the issue

Original research

Barriers in the implementation of the Resuscitation Guidelines: European survey of defibrillation techniques

Letter to the Editor

Mechanical chest compressions in the coronary catheterization laboratory – do not hesitate to go step further!

Original research

Hemodynamic, management, and outcomes of patients admitted to emergency department with heart failure

Original research

National Early Warning Score (NEWS) as an emergency department predictor of disease severity and 90-day survival in the acutely dyspneic patient – a prospective observational study

Original research

Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes

Original research

Solo emergency care by a physician assistant versus an ambulance nurse: a cross-sectional document study