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. 2025 Apr 17;17(4):e82441.
doi: 10.7759/cureus.82441. eCollection 2025 Apr.

First Visit Fallout: Canadian Triage and Acuity Scale (CTAS) and Emergency Department Returns

David Lewis  1 , Jacqueline Fraser  2   3 , Michael Howlett  4 , Matthew Greer  1 , Paul Atkinson  1
Affiliations

First Visit Fallout: Canadian Triage and Acuity Scale (CTAS) and Emergency Department Returns

David Lewis et al. Cureus. .

Abstract

Introduction Unplanned return visits (URVs) to the emergency department (ED) within 72 hours are an important quality indicator in emergency medicine, linked to patient safety and the quality of initial care. This study examines whether the Canadian Triage and Acuity Scale (CTAS) category at the initial visit predicts the likelihood of hospital admission upon URV. Methods A retrospective analysis was conducted over a 12-month period at a tertiary care teaching hospital. URVs were defined as registrations within 72 hours of an initial ED discharge, excluding planned returns. Data were extracted from electronic health records, including demographics, CTAS category, disposition, and admission status. Statistical analyses included Pearson correlation, linear regression, and Fisher's exact test to examine relationships between CTAS and admission risk. Statistical significance was set at p < 0.05. Results Of 57,025 ED attendances, 82.1% (46,793) were discharged, of whom 7.6% (3,566) returned within 72 hours. Among URVs, 14.9% (532) resulted in admission. Admission rates on return varied by initial CTAS level, ranging from 23.1% (CTAS 1) to 4.8% (CTAS 5). CTAS 3 patients represented over half of all visits and the highest absolute number of return admissions. A strong negative correlation was observed between CTAS level and URV admission rate (Pearson r = -0.89; p = 0.04). Linear regression confirmed a statistically significant inverse trend, with each one-point increase in CTAS corresponding to a 5.4% absolute reduction in admission rate (R² = 0.90, p = 0.014). Patients triaged as CTAS 1-2 had a relative risk of 1.90 (95% CI: 1.57 to 2.30) for admission on return compared to those triaged as CTAS 3-5. Conclusions The initial CTAS level is a strong predictor of admission following URVs. Stratified analysis revealed that CTAS 3 patients comprise a clinically important group, both in volume and admission risk. These findings support the use of triage-based reporting in ED quality improvement initiatives.

Keywords: canadian triage and acuity scale; emergency department; hospital admission; patient safety; quality indicators; unplanned return visits.

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Conflict of interest statement

Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. ED discharge rates (%) and URV rates (%) based on initial visit CTAS category
CTAS: Canadian Triage and Acuity Scale; ED: emergency department; URV: unplanned return visit
Figure 2
Figure 2. Subsequent admission rates (%) for URVs based on initial visit CTAS category
CTAS: Canadian Triage and Acuity Scale; URV: unplanned return visit
Figure 3
Figure 3. Rate of admission on return was negatively correlated with initial CTAS level (Pearson r = -0.89 (95 CI -0.99 to -0.03); R² = 0.79; F = 11.25; p = 0.04)
CTAS: Canadian Triage and Acuity Scale
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References

    1. Prioritizing performance measurement for emergency department care: consensus on evidencebased quality of care indicators. Schull MJ, Guttmann A, Leaver CA, et al. CJEM. 2011;13:300-9, E28-43. - PubMed
    1. Reliability of the Canadian Emergency Department Triage and Acuity Scale: Interrater Agreement. Beveridge R, Ducharme J, Janes L, Beaulieu S, Walter S. Ann Emerg Med. 1999;34:155–159. - PubMed
    1. Unscheduled return visits to the pediatric emergency department-one-year experience. Goldman RD, Ong M, Macpherson A. Pediatr Emerg Care. 2006;22:545–549. - PubMed
    1. Unscheduled return visits with and without admission post emergency department discharge. Hu KW, Lu YH, Lin HJ, Guo HR, Foo NP. J Emerg Med. 2012;43:1110–1118. - PubMed
    1. Unscheduled return visits (URV) in adults to the emergency department (ED): a rapid evidence assessment policy review. Trivedy CR, Cooke MW. Emerg Med J. 2015;32:324–329. - PubMed

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