Assessing the need for hospital admission by the Cape Triage discriminator presentations and the simple clinical score

Abstract

Aim: There is uncertainty about how to assess unselected acutely ill medical patients at the time of their admission to hospital. This study examined the use of the Simple Clinical Score (SCS) and the medically relevant Cape Triage discriminator clinical presentations to determine the need for admission to an acute medical unit.

Method: A prospective study of 270 unselected consecutive acute medical admissions. On presentation to hospital patients were grouped into one of 5 risk classes according to their SCS and to one of four Cape Triage colour-coded risk discriminator presentations (CTP).

Results: 221 (82%) patients had an urgent or very urgent CTP. Although 60 patients were deemed very low risk by the SCS at the time of admission, only 13 of these patients a delayed priority CTP. All but three of the 95 patients in high SCS risk classes did not have an urgent or very urgent CTP. The ability of the CTP to predict outcomes was inferior to the SCS--the AUROC for in-hospital death was 0.94 for the SCS and 0.64 for CTP.

Conclusion: Nearly all patients in the highest risk SCS classes were detected as urgent or very urgent by the CTP. However, most patients admitted in the lowest risk SCS class also were considered urgent or very urgent by the CTP and, therefore, had presentations that justified admission. Although CTP predict outcome poorly they can be used together with the SCS to rapidly assess the need for admission and to prioritise management.