Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2020 Aug 17;28(1):81.
doi: 10.1186/s13049-020-00766-1.

Pre-hospital triage performance and emergency medical services nurse's field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

Carl Magnusson  1 , Johan Herlitz  2   3 , Christer Axelsson  2   3
Affiliations
Observational Study

Pre-hospital triage performance and emergency medical services nurse's field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

Carl Magnusson et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: In Sweden, the rapid emergency triage and treatment system (RETTS-A) is used in the pre-hospital setting. With RETTS-A, patients triaged to the lowest level could safely be referred to a lower level of care. The national early warning score (NEWS) has also shown promising results internationally. However, a knowledge gap in optimal triage in the pre-hospital setting persists. This study aimed to evaluate RETTS-A performance, compare RETTS-A with NEWS and NEWS 2, and evaluate the emergency medical service (EMS) nurse's field assessment with the physician's final hospital diagnosis.

Methods: A prospective, observational study including patients (≥16 years old) transported to hospital by the Gothenburg EMS in 2016. Three comparisons were made: 1) Combined RETTS-A levels orange and red (high acuity) compared to a predefined reference emergency, 2) RETTS-A high acuity compared to NEWS and NEWS 2 score ≥ 5, and 3) Classification of pre-hospital nurse's field assessment compared to hospital physician's diagnosis. Outcomes of the time-sensitive conditions, mortality and hospitalisation were examined. The statistical tests included Mann-Whitney U test and Fisher's exact test, and several binary classification tests were determined.

Results: Overall, 4465 patients were included (median age 69 years; 52% women). High acuity RETTS-A triage showed a sensitivity of 81% in prediction of the reference patient with a specificity of 64%. Sensitivity in detecting a time-sensitive condition was highest with RETTS-A (73%), compared with NEWS (37%) and NEWS 2 (35%), and specificity was highest with NEWS 2 (83%) when compared with RETTS-A (54%). The negative predictive value was higher in RETTS-A (94%) compared to NEWS (91%) and NEWS 2 (92%). Eleven per cent of the final diagnoses were classified as time-sensitive while the nurse's field assessment was appropriate in 84% of these cases.

Conclusions: In the pre-hospital triage of EMS patients, RETTS-A showed sensitivity that was twice as high as that of both NEWS and NEWS 2 in detecting time-sensitive conditions, at the expense of lower specificity. However, the proportion of correctly classified low risk triaged patients (green/yellow) was higher in RETTS-A. The nurse's field assessment of time-sensitive conditions was appropriate in the majority of cases.

Keywords: Emergency medical services; Field assessment; Patient safety; Pre-hospital emergency nurse; Triage.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the studied patients
Fig. 2
Fig. 2
Definition of the reference patient
Fig. 3
Fig. 3
RETTS-A, NEWS and NEWS 2 categorisation in accordance with sensitivity, specificity and predictive values
See this image and copyright information in PMC

References

    1. FitzGerald G, Jelinek GA, Scott D, Gerdtz MF. Emergency department triage revisited. Emerg Med J. 2010;27:86–92. - PubMed
    1. Fernandes CMB, Tanabe P, Gilboy N, Johnson LA, McNair RS, Rosenau AM, et al. Five-level triage: a report from the acep/ena five-level triage task force. J Emerg Nurs. 2005;31:39–50. - PubMed
    1. Widgren BR, Jourak M. Medical emergency triage and treatment system (metts): a new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med. 2011;40:623–628. - PubMed
    1. Ruge T, Malmer G, Wachtler C, Ekelund U, Westerlund E, Svensson P, et al. Age is associated with increased mortality in the retts-a triage scale. BMC Geriatr. 2019;19:139. - PMC - PubMed
    1. Lidal IB, Holte HH, Vist GE. Triage systems for pre-hospital emergency medical services - a systematic review. Scandinavian journal of trauma, resuscitation and. Emerg Med. 2013;21:28. - PMC - PubMed

Publication types