Clinical Characteristics and Worsening Prognosis for Undertriage Patients in the Emergency Department: A University Affiliated Hospital Observational Study

ABSTRACT

PURPOSE: Emergency department (ED) overcrowding is a common occurrence, and requires performance of appropriate triage to determine the priority for patient treatments. Undertriage, defined as inappropriate assignment of a low level of severity during triage, delays the initiation of treatment and may lead to deterioration of severely ill or injured patients. The aim of this observational study was to evaluate the clinical characteristics of undertriage patients and their risk exposure to a worsening prognosis. METHODS: Subjects were ED patients admitted to a university affiliated hospital from Jan 1, 2010 to Dec 31, 2010, and they were triaged according to the modified Canadian Triage and Acuity Scale. Patients who were initially categorized as non-emergency cases (scale 4 or 5) but later recategorized as emergency cases (scale 1 or 2) were defined as the undertriage group. Triage patients who did not receive a change of severity categorization were assigned to a low-acuity group for non-emergency cases, and a high-acuity group for emergency cases. The clinical characteristics and worsening prognosis of the undertriage group were compared with low- and high-acuity groups. Worsening prognosis included cardiac arrest and the admission to the intensive care unit. RESULTS: Patients in the undertriage group were 0.9% of the total study participants. The undertriage group predominantly included elderly males with head and neck injuries, or hemato-oncology diseases. Worsening prognosis was less likely in the undertriage group than in the high-acuity group, and more likely than in the low-acuity group. CONCLUSION: Undertriage was not common. However, worsening prognosis was very high in the undertriage group as compared to the low-acuity group. Prudential concern is required to avoid undertriage with the elderly, and patients with head and neck injuries, or hemato-oncology diseases.