Validity of the Korean Triage and Acuity Scale for predicting 30-day mortality due to severe trauma: a retrospective single-center study

Abstract

Purpose: Since January 2016, emergency medical centers in South Korea have used the Korean Triage and Acuity Scale (KTAS) as the initial triage tool for all patients, including trauma patients, who visited the emergency department (ED). This present study aimed to assess the validity of the KTAS for predicting 30-day mortality due to severe trauma.

Methods: This retrospective study included patients with severe trauma (injury severity score ≥ 16) from January 2016 to December 2017. Using KTAS, all patients were triaged as levels 1, 2, 3, and 4 by triage nurses. The primary outcome was 30-day mortality, and the secondary outcome was disposition at the ED. Disposition at the ED included admission to the general ward, intensive care unit, or operation room or death in the ED.

Results: Of the 827 included patients, 30-day mortality was observed in 14.9% (n = 123) of patients. Mortality was observed in 52.5% (n = 42), 15.5% (n = 69), 4.1% (n = 12), and 0.0% (n = 0) of patients in levels 1, 2, 3, and 4, respectively. The Cox proportional hazard regression analysis showed that compared to level 3, level 1 [hazard ratio (HR) 4.868; 95% confidence interval (CI) 2.341-10.119] and level 2 (HR 2.070; 95% CI 1.083-3.956) were independently associated with 30-day mortality. Patients with lower KTAS levels were more likely to be admitted to the operation room and were more likely to die in the ED.

Conclusion: Lower KTAS levels were associated with higher 30-day mortality due to severe trauma. KTAS shows adequate validity for predicting 30-day mortality from severe trauma.

Keywords: Korean Triage and Acuity Scale; Mortality; Trauma; Triage.