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Three Part Question

In the [triage of Emergency Department patients], is [computer-assisted system better than standard nurse-led system] in [improving accuracy and hence safety]?

Clinical Scenario

Your Head of Department is considering the use of a computerised triaging system. He wonders if this is a better method of triaging patients, compared to the traditional nurse-led triaging system.

Search Strategy

Medline 1950 to August Week 1 2010 using OVID interface

[exp Triage] AND
[exp Emergency Service, Hospital OR emergency department ti.ab.sw.sh] AND
[exp Decision Making, Computer-Assisted OR (computer$ed or (computer adj5 assisted)) ti.ab.sw.sh] AND
LIMIT to (english language and humans)

Search Outcome

18 studies were found.
5 studies were relevant to the subject matter.
Only 1 study answered the question directly.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Dong et al 2005 Canada	Emergency triage nurses	Prospective observational study	1. agreement between memory-based triage and eTRIAGE	1. poor to fair agreement (k = 0.202, 95% CI 0.150-0.254) between memory-based triage and eTRIAGE (n=693)	Poor external validity – only one center study Expert panel assessment was done retrospectively based on clinical records rather than real time
			2. agreement between memory-based triage and expert panel	2. fair agreement (k = 0.263, 95% CI 0.133-0.394) between memory-based triage and expert panel (n=97)
			3. agreement between eTRIAGE and expert panel	3. moderate agreement (k = 0.426, 95% CI 0.289-0.564) between eTRIAGE and expert panel (n=97)

Comment(s)

To compare the accuracy of either triage system, the triage level generated by either system needs to be compared against a ‘gold standard’. In the study by Dong et al, the gold standard was the expert panel opinion of what the triage level should be. There are not many such studies available in the literature. This is likely due to the difficulty in designing and performing this type of comparative study.

Clinical Bottom Line

In the triaging of emergency department patients, computerized triage maybe more accurate than nurse-led (memory) triage. The evidence for this conclusion is based only one study.

Level of Evidence

Level 2 - Studies considered were neither 1 or 3.

References

1. Dong SL, Bullard MJ, Meurer DP, Colman I, Blitz S, Holroyd BR, Rowe BH Emergency Triage: Comparing a Novel Computer Triage Program with Standard Triage Academic Emergency Medicine 2005; 12:502-507