Comparison between Emergency Severity Index and Heart Failure Triage Scale in heart failure patients: A randomized clinical trial

doi:10.5847/wjem.j.1920-8642.2019.04.004

Abstract

Abstract:

BACKGROUND: It is not clear whether Emergency Severity Index (ESI) is valid to triage heart failure (HF) patients and if HF patients benefit more from a customized triage scale or not. The aim of study is to compare the effect of Heart Failure Triage Scale (HFTS) and ESI on mistriage among patients with HF who present to the emergency department (ED).
METHODS: A randomized clinical trial was conducted from April to June 2017. HF patients with dyspnea were randomly assigned to HFTS or ESI groups. Triage level, used resources and time to electrocardiogram (ECG) were compared between both groups among HF patients who were admitted to coronary care unit (CCU), cardiac unit (CU) and discharged patients from the ED. Content validity was examined using Kappa designating agreement on relevance (K*). Reliability of both scale was evaluated using inter-observer agreement (Kappa).
RESULTS: Seventy-three and 74 HF patients were assigned to HFTS and ESI groups respectively. Time to ECG in HFTS group was significantly shorter than that of ESI group (2.05 vs. 16.82 minutes). Triage level between HFTS and ESI groups was significantly different among patients admitted to CCU (1.0 vs. 2.8), cardiac unit (2.26 vs. 3.06) and discharged patients from the ED (3.53 vs. 2.86). Used resources in HFTS group were significantly different among triage levels (H=25.89; df=3; P<0.001).
CONCLUSION: HFTS is associated with less mistriage than ESI for triaging HF patients. It is recommended to make use of HFTS to triage HF patients in the ED.

Key words: Dyspnea, Heart failure, Triage, Emergency Severity Index

Ahmad Pouyamehr, Amir Mirhaghi, Mohammad Davood Sharifi, Ali Eshraghi. Comparison between Emergency Severity Index and Heart Failure Triage Scale in heart failure patients: A randomized clinical trial[J]. World Journal of Emergency Medicine, 2019, 10(4): 215-221.

Figures/Tables 5

Figure 1.

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Table 1

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Characteristics	All	HFTS	ESI	P value
Age (years)	62.53±18.4	61.90±12.68	63.15±13.57	0.556
Gender male, n (%)	65 (41.9)	37 (23.9)	28 (18.1 )	0.085
Mode of arrival; walking, n (%)	151 (97.41)	74 (47.74)	77 (49.67)	0.560
Triage level	2.69±0.90	2.45±1.05	2.92±0.63	0.001
Level I	23	18	5	0.001
Level II	23	21	2	0.001
Level III	90	23	67	0.001
Level IV	19	15	4	0.001
Used resources	3.89±1.41	4.29±1.58	3.50±1.11	0.001
Level I	5.43±1.72	5.83±1.68	4.00±1.00	0.032
Level II	4.39±1.26	4.42±1.28	4.00±1.41	0.659
Level III	3.54±1.11	3.69±1.06	3.49±1.13	0.453
Level IV	3.10±0.93	3.20±1.58	2.75±0.50	0.409
Discharge, n (%)	58 (37.4)	28 (18.1)	30 (19.4)	0.060
Cardiac unit, n (%)	59 (38.1)	30 (19.4)	29 (18.7)	0.060
CCU, n (%)	30 (19.4)	15 (9.7)	15 (9.7)	0.060
Death, n (%)	2 (1.3)	2 (1.3)	0 (0)	0.060
Leaving against advise, n (%)	6 (3.9)	2 (1.3)	4 (3.9)	0.060
Triage time (minutes)	2.50±0.71	2.89±0.64	2.11±0.64	0.001
Time to ECG (minutes)	9.48±10.26	2.05±0.55	16.82±10.03	0.001
Time to O₂ therapy (minutes)	20.00±14.37	18.61±15.74	21.38±12.84	0.001
Time to physician visit (minutes)	17.54±14.46	17.49±16.07	17.58±12.78	0.967
Time to cardiologist visit (minutes)	121.23±80.59	105.59±74.96	136.66±83.42	0.160
Systolic BP at triage (mmHg)	121.51±19.44	119.18±23.09	123.82±14.78	0.024
Diastolic BP at triage (mmHg)	80.10±12.98	77.84±12.12	82.33±13.48	0.031
Heart rate at triage (beats/minute)	87.60±19.98	89.02±23.00	86.20±16.48	0.382
Respiratory rate at triage (per minute)	18.23±2.72	18.29±2.66	18.17±2.80	0.787
O₂ saturation at triage (%)	94.25±5.02	93.97±4.70	94.52±5.33	0.496

Paramaters	All	HFTS	ESI	P value
Used resources
Discharged patients (28:30)*	3.43±0.97	3.46±1.03	3.40±0.93	0.804
CU patients (30:29)	3.86±2.66	4.30±1.23	3.40±1.15	0.001
CCU patients (15:15)	4.90±1.51	5.60±1.59	4.20±1.08	0.009
Triage level
Discharged patients (28:30)	3.18±0.60	3.53±0.50	2.86±0.50	0.001
CU patients (30:29)	2.60±0.77	2.26±0.52	3.06±0.79	0.001
CCU patients (15:15)	4.90±1.51	1.00±0.00	2.80±0.56	0.001

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