The association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems: an observational multicenter study
Abstract Background Effective triage systems are crucial for prioritizing patients based on urgency and optimizing resource utilization. An ideal triage system is expected to have low resource utilization, hospitalization and mortality among patients classified at low urgency levels. Furthermore, it...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
|
| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-025-01392-5 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850042782359486464 |
|---|---|
| author | Marit E. van Wegen Laura F. C. Fransen Wendy A. M. H. Thijssen Georgios Alexandridis Bas de Groot |
| author_facet | Marit E. van Wegen Laura F. C. Fransen Wendy A. M. H. Thijssen Georgios Alexandridis Bas de Groot |
| author_sort | Marit E. van Wegen |
| collection | DOAJ |
| description | Abstract Background Effective triage systems are crucial for prioritizing patients based on urgency and optimizing resource utilization. An ideal triage system is expected to have low resource utilization, hospitalization and mortality among patients classified at low urgency levels. Furthermore, it should exhibit an increase in the risk of hospitalization and mortality as urgency levels increase, ensuring the most critically ill patients receive priority care first. However, it is unclear which triage system performs best. Objective To compare the performance of the Manchester Triage System (MTS), the Emergency Severity Index (ESI), and the Netherlands Triage Standard (NTS) by investigating the association between urgency levels and resource utilization, hospitalization and in-hospital mortality in Emergency Department (ED) patients. Methods Observational multicenter cohort study using data from the Netherlands Emergency department Evaluation Database, comprising seven representative EDs in six Dutch hospitals. All consecutive ED patients with a registered urgency level were included. Resource utilization, hospitalization and mortality were measured across all urgency levels. In each triage system, multivariable logistic regression was used to assess the association between urgency level and in-hospital mortality and hospitalization, adjusting for age, sex, presenting complaints and hospital type. Results A total of 696,518 ED visits (MTS 320,406 (46.1%), ESI 214,267 (30.8%), NTS 161,845 (23.3%) patients) were included. Resource utilization was substantially lower in the lowest urgency level of the ESI compared to the MTS and NTS. Hospitalization to a regular ward, cardiac, medium or intensive care unit in the least urgent level was 3.9% in the ESI, considerably lower than in the MTS (23.1%) and NTS (34.3%) (P < 0.05). Mortality in the lowest urgency level of the ESI was 0.8%, while in the MTS and NTS this was 6.3% and 12.4%, respectively (P < 0.05). In the ESI, the risk (Adjusted Odds Ratios) for hospitalization and mortality increased much more with increasing urgency levels compared to the MTS and NTS. Conclusion This study suggests that the ESI may be more effective in distinguishing between patients with low and high urgency, with a reduced risk of undertriage when compared to the MTS and NTS. |
| format | Article |
| id | doaj-art-51eda1fb034c40448db5adf9e6a1edbd |
| institution | DOAJ |
| issn | 1757-7241 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj-art-51eda1fb034c40448db5adf9e6a1edbd2025-08-20T02:55:27ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412025-05-0133111210.1186/s13049-025-01392-5The association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems: an observational multicenter studyMarit E. van Wegen0Laura F. C. Fransen1Wendy A. M. H. Thijssen2Georgios Alexandridis3Bas de Groot4Department of Emergency Medicine, Rijnstate HospitalDepartment of Emergency Medicine, Canisius Wilhelmina HospitalDepartment of Emergency Medicine, Catharina HospitalDepartment of Emergency Medicine, Canisius Wilhelmina HospitalDepartment of Emergency MedicineAbstract Background Effective triage systems are crucial for prioritizing patients based on urgency and optimizing resource utilization. An ideal triage system is expected to have low resource utilization, hospitalization and mortality among patients classified at low urgency levels. Furthermore, it should exhibit an increase in the risk of hospitalization and mortality as urgency levels increase, ensuring the most critically ill patients receive priority care first. However, it is unclear which triage system performs best. Objective To compare the performance of the Manchester Triage System (MTS), the Emergency Severity Index (ESI), and the Netherlands Triage Standard (NTS) by investigating the association between urgency levels and resource utilization, hospitalization and in-hospital mortality in Emergency Department (ED) patients. Methods Observational multicenter cohort study using data from the Netherlands Emergency department Evaluation Database, comprising seven representative EDs in six Dutch hospitals. All consecutive ED patients with a registered urgency level were included. Resource utilization, hospitalization and mortality were measured across all urgency levels. In each triage system, multivariable logistic regression was used to assess the association between urgency level and in-hospital mortality and hospitalization, adjusting for age, sex, presenting complaints and hospital type. Results A total of 696,518 ED visits (MTS 320,406 (46.1%), ESI 214,267 (30.8%), NTS 161,845 (23.3%) patients) were included. Resource utilization was substantially lower in the lowest urgency level of the ESI compared to the MTS and NTS. Hospitalization to a regular ward, cardiac, medium or intensive care unit in the least urgent level was 3.9% in the ESI, considerably lower than in the MTS (23.1%) and NTS (34.3%) (P < 0.05). Mortality in the lowest urgency level of the ESI was 0.8%, while in the MTS and NTS this was 6.3% and 12.4%, respectively (P < 0.05). In the ESI, the risk (Adjusted Odds Ratios) for hospitalization and mortality increased much more with increasing urgency levels compared to the MTS and NTS. Conclusion This study suggests that the ESI may be more effective in distinguishing between patients with low and high urgency, with a reduced risk of undertriage when compared to the MTS and NTS.https://doi.org/10.1186/s13049-025-01392-5TriageUrgency levelEmergency medical servicesUndertriageOvertriageIn-hospital mortality |
| spellingShingle | Marit E. van Wegen Laura F. C. Fransen Wendy A. M. H. Thijssen Georgios Alexandridis Bas de Groot The association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems: an observational multicenter study Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Triage Urgency level Emergency medical services Undertriage Overtriage In-hospital mortality |
| title | The association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems: an observational multicenter study |
| title_full | The association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems: an observational multicenter study |
| title_fullStr | The association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems: an observational multicenter study |
| title_full_unstemmed | The association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems: an observational multicenter study |
| title_short | The association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems: an observational multicenter study |
| title_sort | association between urgency level and hospital admission mortality and resource utilization in three emergency department triage systems an observational multicenter study |
| topic | Triage Urgency level Emergency medical services Undertriage Overtriage In-hospital mortality |
| url | https://doi.org/10.1186/s13049-025-01392-5 |
| work_keys_str_mv | AT maritevanwegen theassociationbetweenurgencylevelandhospitaladmissionmortalityandresourceutilizationinthreeemergencydepartmenttriagesystemsanobservationalmulticenterstudy AT laurafcfransen theassociationbetweenurgencylevelandhospitaladmissionmortalityandresourceutilizationinthreeemergencydepartmenttriagesystemsanobservationalmulticenterstudy AT wendyamhthijssen theassociationbetweenurgencylevelandhospitaladmissionmortalityandresourceutilizationinthreeemergencydepartmenttriagesystemsanobservationalmulticenterstudy AT georgiosalexandridis theassociationbetweenurgencylevelandhospitaladmissionmortalityandresourceutilizationinthreeemergencydepartmenttriagesystemsanobservationalmulticenterstudy AT basdegroot theassociationbetweenurgencylevelandhospitaladmissionmortalityandresourceutilizationinthreeemergencydepartmenttriagesystemsanobservationalmulticenterstudy AT maritevanwegen associationbetweenurgencylevelandhospitaladmissionmortalityandresourceutilizationinthreeemergencydepartmenttriagesystemsanobservationalmulticenterstudy AT laurafcfransen associationbetweenurgencylevelandhospitaladmissionmortalityandresourceutilizationinthreeemergencydepartmenttriagesystemsanobservationalmulticenterstudy AT wendyamhthijssen associationbetweenurgencylevelandhospitaladmissionmortalityandresourceutilizationinthreeemergencydepartmenttriagesystemsanobservationalmulticenterstudy AT georgiosalexandridis associationbetweenurgencylevelandhospitaladmissionmortalityandresourceutilizationinthreeemergencydepartmenttriagesystemsanobservationalmulticenterstudy AT basdegroot associationbetweenurgencylevelandhospitaladmissionmortalityandresourceutilizationinthreeemergencydepartmenttriagesystemsanobservationalmulticenterstudy |