Dokuz Eylül Triyaj Sistemi: Beş kategorili triyaj algoritmi, geçerlilik ve güvenilirlik çalışması

Year 2019, Volume: 2 Issue: 3, 1 - 7, 30.09.2019

Ozlem Dikme , Rıdvan Atilla Nese Colak Oray Gulcim Saracoglu Mehmet Can Girgin Pınar Yesim Akyol

Abstract

Giriş: Triyaj sistemleri, acil
servis bekleme alanlarında hastalığın ciddiyetini tespit etmede faydalı
araçlardır. Hastalık ve hasta profili açısından benzerlik eksikliği nedeniyle,
her triyaj sistemi başka bir ülkede etkili olmayabilir. Dokuz Eylül Triyaj
Sistemi beş seviyeli bir triyaj sistemi olarak geliştirildi ve bu yazıda Dokuz
Eylül Triyaj Sistemi üçüncü seviye bir acil serviste kullanılarak geçerliliği
ve güvenilirliği değerlendirildi.

Yöntem: Bu çalışma üçüncü
basamak acil serviste yapıldı. Çalışmaya bir ay içerisinde acil servise
başvuran ve sistematik örnekleme yöntemi ile seçilen hastalar alındı. Hastane
yatışı, acil serviste kalış süresi, 48 saat sonundaki mortalite, kaynak
kullanımları geçerlilik için değerlendirildi ve kör eşleştirilmiş triyaj
kategorileri güvenilirlik için ağırlıklı kappa analizi ile karşılaştırıldı.

Bulgular: Beş yüz altmış yedi
hasta çalışmaya alındı; 30'u dışlandı. Kalan 537 hastanın %55'i kadındı ve
ortanca yaş 46 idi. Hastalardan yedisinin triyaj seviyesi-1 (%1.3), 142'sinin
triyaj seviyesi-2 (%26.4), 167'sinin triyaj seviyesi-3 (%31.1), 166'sının
triyaj seviyesi-4 (%30.9) ve 55'inin triyaj seviyesi-5 (%10,3) bulundu. Triyaj
kategorileri için ağırlıklı kappa, 0.825 olarak bulundu. Triyaj kategoriri
kaynak kullanımı, hastanede yatış oranları, ortalama kalış süresi ve 48 saat
mortalite, triyaj seviyesi ile kuvvetli olarak ilişkili bulundu. Aşırı triyaj
oranı %15,5, triyaj altı oranı %3,7 ve triyaj sisteminin triyaj kategorisi 1 ve
2'deki hastalar için duyarlılığı %99,3 ve özgüllüğü %96 olarak hesaplandı.

Sonuçlar: Dokuz Eylül Triyaj
Sistemi, bir üçüncü derece acil serviste klinik uygulamaya yerleştirilecek
kadar güvenilir ve geçerli beş kategorili bir triyaj algoritmasıdır. Dokuz
Eylül Triyaj Sisteminin, canlandırma ve acil bakım ihtiyacı olan hastaları
güvenle tespit edip eleyebildiği bu çalışma ile rapor edilmiştir.

Keywords

Triyaj, geçerlilik, güvenilirlik

Supporting Institution

yok

Dokuz Eylul Triage System: A five category triage algorithm, reliability and validity study.

Abstract

Introduction:
Triage systems are useful tools to detecting severity of illness in the
emergency department’s waiting areas. Because of the lack of similarity in
terms of disease and the patient profile each triage system may not be
effective in another country. Dokuz Eylul Triage System was developed as a
five-level triage system and this paper evaluates validity and reliability of
Dokuz Eylul Triage System to use in a tertiary Turkish emergency department.

Methods:
This study was performed in a tertiary emergency department. Patients with any
symptoms who were admitted to the emergency department in one-month period and
selected by systematic sampling method were included into the study. Hospital
admission, length of stay in the emergency department, 48h mortality, resource
uses were assessed for validity and blinded paired triage assignments were
compared with weighted kappa analysis for reliability.

Results:
Five-hundred-sixty-seven patients were enrolled; 30 were excluded. The
resulting of 537 patients was 55% female and had a median age of 46 years.
Seven of them were triage level-1 (1.3%), 142 of them were level-2 (26.4%), 167
of them were level-3 (31.1%), 166 of them were level-4 (30.9%) and 55 of them
were level-5 (10.3%). Weighted kappa for triage assignment was found as 0.825.
Resource use, hospitalization rates, mean length of stay and 48h mortality were
found as strongly associated with triage level. Over-triage rate was 15.5%,
under-triage rate was 3.7% and the sensitivity and specificity of the triage system
were calculated 99.3% and 96%.

Conclusions:
Dokuz Eylul Triage System is a reliable and validated five-category triage
algorithm for Turkey to be implanted into clinical practice of a tertiary
emergency department. We report that Dokuz Eylul Triage System could be able to
detect and sieve the patients safely who need resuscitation and emergent care.

Keywords

triage, reliability, validity

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