Assessment of Sydney Triage to Admission Risk Tool (START) on Egyptian Emergency Department performance

Background: Efficient triage enhances emergency department (ED) operations by minimizing overcrowding, supporting prompt clinical decision-making, and potentially lowering hospital mortality rates. This study assesses the impact of the Sydney Triage to Admission Risk Tool (START) on the performance of the Emergency Department at Menoufia University Hospital, Egpyt. Methods: A randomized controlled trial was conducted on 399 patients who presented to the ED of Menoufia University Hospitals between July and December 2024. Results: There was a significant reduction in the mean ED length of stay in the START group compared to the standard group (204.15 ± 123.48 vs. 234.67 ± 141.62 minutes, p < 0.02). A higher proportion of patients in the START group had ED stays of less than four hours (84.0% vs. 73.9%, p < 0.01). Additionally, there was a statistically significant decrease in the mortality rate in the START group compared to the standard group (5% vs. 10.6%, p < 0.02). The START score demonstrated excellent predictive performance, with an area under the curve (AUC) of 0.92 (95% CI: 0.90-0.95), and predicted patient admission with a sensitivity of 91.4% and a specificity of 76.6%. Conclusion: The START tool significantly improved ED performance by reducing the mean length of stay and increasing the proportion of patients discharged within four hours.