Comparison of triple triage system and CTAS (Canadian Triage and Acuity Scale) system in the emergency department

Background/Aim: Triage systems are crucial for determining patient care priorities and efficiently utilizing resources in emergency departments. The aim of this study is to compare the effectiveness of the three-stage triage system (TR) and the Canadian Triage and Acuity Scale (CTAS) system in terms of patient safety, resource management, and alignment with expert opinions in an adult emergency department. Methods: A prospective, cross-sectional, single-blind clinical study was conducted in an adult emergency department between October 1 and October 15, 2021. Patients aged 15 years and older with a Glasgow Coma Scale (GCS) score of 15 were included in the study. Trauma patients, patients transported by ambulance, and patients under 15 years of age were excluded from the study. CTAS was applied by a single emergency medicine resident on odd days of the month, while TR was applied on the even days. The specialist physician who provided the reference triage categories was unaware of the initial assessments. Primary outcomes included inter-rater agreement (weighted kappa coefficient), triage accuracy, and resource utilization patterns. Statistical analysis used the Kruskal-Wallis H test, Fisher's exact test, and a weighted kappa coefficient with a significance level set at P<0.05. Results: A total of 620 patients were evaluated (TR: n=290, CTAS: n=330). CTAS demonstrated significantly higher agreement with expert opinion compared to TR (κ=0.375, P<0.001) (κ=0.835, P<0.001). In CTAS, the rate of inadequate triage was significantly lower (12%) compared to TR (28%). CTAS demonstrated a more balanced patient distribution across emergency levels and rational resource utilization, resulting in appropriate requests for radiological examinations at T3 level (32.35% compared to 78.95% in the yellow zone of TR, P<0.001). Hospital admission rates were higher in CTAS (seven patients) compared to TR (one patient). Conclusion: The CTAS system demonstrated significantly higher compliance and lower triage error rates compared to the TR system, with expert consensus, thereby showing superior performance in terms of patient safety and resource management. The implementation of CTAS in emergency departments may improve the quality of patient care and optimize resource utilization.