Agreement of Prehospital Severity Assignment: Comparisons among 3 Different Patient Assessment Tools in Urban Emergency Medical Service
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Abstract
Introduction: Emergency Medical Services (EMS) in Thailand are considered as multi-tiered response system providing medical care regarding the degrees of emergency and severity prioritization. Thus, effective triage tools are mandatory for efficient resource management to achieve productivity during pre-hospital emergencies and casualties.
Objectives: To compare the agreement and consistency in severity assignment between the standard in-hospital emergency severity index (ESI) and the pre-hospital assessment tools, including the phone triage with criteria-based dispatch protocol and the on-scene triage using the National Early Warning Score (NEWS).
Methods: This is a retrospective, descriptive study of EMS missions conducted by a single urban EMS center, Vajira Hospital. Data including phone triage medical dispatch codes, pre-hospital NEWS and ESI levels were collected and analyzed.
Results: A total of 950 EMS missions were evaluated, among which 93.6% were categorized as ‘red code’. The phone triage medical dispatch demonstrated the over-triage rate of 26.2% and the under-triage rate of only 1.7% with slight reliability (Kappa 0.165; p-value < 0.001) when compared to ESI levels, whereas the pre-hospital NEWS resulted in the under-triage rate of 47.8% with fair reliability (Kappa 0.344; p-value < 0.001).
Conclusion: For pre-hospital settings, the phone triage using medical dispatch codes provides more accurate severity assignment with optimal outcomes consistent with the international recommendations, whereas the NEWS seems to generate excessive undertriage rate.
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References
National Institute for Emergency Medicine. Interfacility Patient Transfer. Bangkok: Ultimate printing, 2014. p. 1-5.
National Institute for Emergency Medicine. Thailand Emergency Medical Service Dispatch guideline 2008. Bangkok: Beyond Publishing, 2009. p. 1-126.
Eystein G, Jo K-J. Does the Norwegian emergency medical dispatch classification as non-urgent predict no need for pre-hospital medical treatment? An observational study. Scand. J. Trauma, Resusc. Emerg. Med. 2016; 24: 65.
American Society for Testing and Materials (ASTM). Standard Practice for Emergency Medical Dispatch Management. Annual Book of ASTM Standards. 1994: p. 1-86.
National Institute for Emergency Medicine. Guidelines for Emergency Triage Education and Practice in Thailand 2011 journals. Bangkok: Beyond publishing, 2015. p. 1-38.
National Institute for Emergency Medicine. Quality and practice of Emergency Medical Service. Bangkok, 2010: p. 9-19.
Eirin NE, Torben W, Steinar H, Erik Z. Dispatch guideline adherence and response interval-a study of emergency medical calls in Norway. BMC Emergency Medicines 2016; 16: 40.
Marko H, Sami L, Tom S, Tero IAK. Medical priority dispatch codes-comparison with National Early Warning Score. Scand. J. Trauma, Resusc. Emerg. Med. 2016; 24: 142.
National Institute for Emergency Medicine. Annual report. Bangkok, 2017: p. 39.
American College of Surgeons-COT. Resources for optimal care of injured patient. Chicago: American College of Surgeons-COT 2014; p. 25-9.
Silcock DJ, Corfield AR, Gowens PA, Rooney KD. Validation of the National Early Warning Score in the prehospital setting. Resuscitation. 2015;89: 31–5.
Supaluck C, Thanyarus P, Ekapan T. The Development guidelines Incident dispatch code of command and control center Khon Kaen hospital. Khon Kaen, 2016; p. 2-17.
Daniel WW. Biostatistics A Foundation for Analysis in the Health Sciences. 6th ed. John Wiley&Sons, Inc. 1995; p. 533-4.
Nicki G, Paula T, Debbie T, Alexander MR. Emergency Severity Index (ESI) A Triage Tool for Emergency Department Care. Version 4, 2012 Edition; p. 7-38.
Bente B, Linda G, Signe S. National Early Warning Score (NEWS) as an emergency department predictor of disease severity and 90-day survival in the acutely dyspneic patient – a prospective observational study. Scand. Scand. J. Trauma, Resusc. Emerg. Med. 2016 Jun 2; 24: 80: p. 1-8.
Mary LM. Interrater reliability the kappa statistic. Biochem Med (Zagreb). 2012 Oct; 22(3): 276-82.
Fullerton JN, Price CL, Silvey NE. Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment?. Resuscitation. 2012;83(5): 557–62.