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. 2019 Apr 15;34(14):e114.
doi: 10.3346/jkms.2019.34.e114.

Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study

Ji Ho Ryu  1 , Mun Ki Min  1 , Dae Sup Lee  1 , Seok Ran Yeom  2 , Seong Hwa Lee  2 , Il Jae Wang  2 , Suck Ju Cho  2 , Seong Youn Hwang  3 , Jun Ho Lee  4 , Yong Hwan Kim  4
Affiliations

Changes in Relative Importance of the 5-Level Triage System, Korean Triage and Acuity Scale, for the Disposition of Emergency Patients Induced by Forced Reduction in Its Level Number: a Multi-Center Registry-based Retrospective Cohort Study

Ji Ho Ryu et al. J Korean Med Sci. .

Abstract

Background: The 5-level triage tool, the Korean Triage and Acuity Scale (KTAS), was developed based on the Canadian Triage and Acuity Scale and has been used for triage in all emergency medical institutions in Korea since 2016. This study evaluated the association between the decrease in level number and the change in its relative importance for disposition in the emergency department (ED).

Methods: Using the registry of the National Emergency Department Information System (NEDIS) ver. 3.1, data regarding consecutive emergency patients from March 2017 to October 2017 were reviewed retrospectively. Reconfiguring KTAS levels, a total of 15 multinomial logistic regression models (KTAS_0 to KTAS_14), including the KTAS, its variants, and covariates were constructed to determine significant factors affecting ED disposition. The relative importance of each model was obtained using a dominance analysis.

Results: A total of 79,771 patients were included in the analysis. In the model KTAS_0, the KTAS and 8 covariates were found to be significantly related to ED disposition. The KTAS and the decision maker of each ED visit, whether it was the physician or others, had the largest relative importance, 34.8% and 31.4%, respectively (P < 0.001). In other models of KTAS variants, including 4-level, 3-level and 2-level, the rates of the KTAS decreased to 31.8% (interquartile range [IQR], 28.9-34.2), 26.4% (IQR, 23.2-31.0), and 18.7% (IQR, 7.5-24.9), respectively (P = 0.016). On the other hand, the rates for covariates tended to be larger for smaller triage levels and so there was a significant interaction effect between the KTAS and the covariates according to the triage level (P < 0.001).

Conclusion: The 5-level triage tool, the KTAS, had the largest relative importance among the predictors affecting ED disposition only at its original level. Therefore, it is recommended that no attempt should be made to reduce the number of levels in the triage tool.

Keywords: Emergencies; Logistic Models; Registries; Triage.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Flow diagram.
Fig. 2
Fig. 2. Conditional dominance statistics of variables in model with the KTAS. After a total of 511 multinomial logistic regression models were constructed through a combination of the KTAS original and covariates, the conditional dominance statistics of each variable were derived from averaging the 9 within-order subsets (C1–C9) of their R2s. Overall, the values tended to decrease as the order placement rose. Among the variables, both the KTAS original and the decision maker of ED visit had more than twice as high values as the other variables.
KTAS = Korean Triage and Acuity Scale, ED = emergency department.
Fig. 3
Fig. 3. General dominance and relative importance in various models with the KTAS and its variants. (A, B) General dominance statistics and relative importance rates for each variable in various models, which were constructed with covariates and the KTAS original and its variants. (A) The values of all covariates show a constant pattern regardless of the type of model; however, the KTAS was vulnerable to changes in the type of model (P < 0.001). (B) The values of the KTAS show the same pattern as (A), but the other variables show corresponding values as the number of the KTAS model increases (P < 0.001).
KTAS = Korean Triage and Acuity Scale, ED = emergency department.
Fig. 4
Fig. 4. Relative importance of 2 major variables with decreasing number of triage levels. Comparing the 2 major variables with the highest relative importance rates, the value of the KTAS decreased correspondingly as the level number decreased while the decision maker of ED visit tended to increase as the number of triage levels decreased (P < 0.001).
KTAS = Korean Triage and Acuity Scale, ED = emergency department.
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Comment in

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