Predicting admission at triage: are nurses better than a simple objective score?

Cameron, A., Ireland, A. J., McKay, G. A., Stark, A. and Lowe, D. J. (2016) Predicting admission at triage: are nurses better than a simple objective score? Emergency Medicine Journal, 34(1), pp. 2-7. (doi: 10.1136/emermed-2014-204455)

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Aim: We compared two methods of predicting hospital admission from ED triage: probabilities estimated by triage nurses and probabilities calculated by the Glasgow Admission Prediction Score (GAPS). Methods: In this single-centre prospective study, triage nurses estimated the probability of admission using a 100 mm visual analogue scale (VAS), and GAPS was generated automatically from triage data. We compared calibration using rank sum tests, discrimination using area under receiver operating characteristic curves (AUC) and accuracy with McNemar’s test. Results: Of 1829 attendances, 745 (40.7%) were admitted, not significantly different from GAPS’ prediction of 750 (41.0%, p=0.678). In contrast, the nurses’ mean VAS predicted 865 admissions (47.3%), overestimating by 6.6% (p<0.0001). GAPS discriminated between admission and discharge as well as nurses, its AUC 0.876 compared with 0.875 for VAS (p=0.93). As a binary predictor, its accuracy was 80.6%, again comparable with VAS (79.0%), p=0.18. In the minority of attendances, when nurses felt at least 95% certain of the outcome, VAS’ accuracy was excellent, at 92.4%. However, in the remaining majority, GAPS significantly outperformed VAS on calibration (+1.2% vs +9.2%, p<0.0001), discrimination (AUC 0.810 vs 0.759, p=0.001) and accuracy (75.1% vs 68.9%, p=0.0009). When we used GAPS, but ‘over-ruled’ it when clinical certainty was ≥95%, this significantly outperformed either method, with AUC 0.891 (0.877–0.907) and accuracy 82.5% (80.7%–84.2%). Conclusions: GAPS, a simple clinical score, is a better predictor of admission than triage nurses, unless the nurse is sure about the outcome, in which case their clinical judgement should be respected.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Ireland, Mr Alastair and Lowe, Dr David and McKay, Dr Gerard and Cameron, Dr Allan
Authors: Cameron, A., Ireland, A. J., McKay, G. A., Stark, A., and Lowe, D. J.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Emergency Medicine Journal
Publisher:BMJ Publishing Group
ISSN (Online):1472-0213
Published Online:10 February 2016

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