Validation of systemic inflammatory response syndrome criteria without white blood cell count in Korean Triage and Acuity Scale

Sun, Junhyun; Chung, Heajin; Jang, Hyeyoung; Kim, Sangil; Lee, Youngjoo; Park, Joonbum

J Korean Soc Emerg Med > Volume 30(3); 2019 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2019;30(3): 232-238.

Validation of systemic inflammatory response syndrome criteria without white blood cell count in Korean Triage and Acuity Scale

Junhyun Sun, Heajin Chung

, Hyeyoung Jang

, Sangil Kim

, Youngjoo Lee, Joonbum Park

Department of Emergency Medicine, Soonchunhyang University Hospital, Seoul, Korea

Correspondence

Joonbum Park ,Tel: 02-709-9117, Fax: 02-710-3199, Email: jesumania@gmail.com,

Received: September 8, 2018; Revised: October 22, 2018 Accepted: October 24, 2018. Published online: June 30, 2019.

ABSTRACT

Objective:
The systemic inflammatory response syndrome (SIRS) criteria used in the triage scale have been implemented incompletely without laboratory data, such as the white blood cell (WBC) count, so the validity of SIRS as a triage tool has been uncertain. This study assessed the validity of the Korean Triage and Acuity Scale (KTAS) in applying SIRS with or without a WBC count.
Method:
The KTAS level was simulated by the number of SIRS criteria. This new KTAS level that did not apply the WBC count was defined as the partial-simulated KTAS (PS-KTAS), and the KTAS level including the WBC count was called the total-simulated KTAS (TS-KTAS). The authors used the intensive care unit (ICU), overall admission rate, and use of emergent interventions as the primary outcomes.
Results:
A total of 1,077 patients with a suspected infection were triaged using the SIRS in KTAS. Multivariable logistic regression analysis showed that the odds ratio for overall admission was greater with a higher KTAS level than with KTAS level 4 in both the PS-KTAS and TS-KTAS. All areas under the curve of the PS- and TS-KTAS for ICU admission and emergent intervention rate both showed very low discriminant powers.
Conclusion:
Compared to TS-KTAS, PS-KTAS showed a similar or partially better relationship between the KTAS level and the use of critical medical resource. Future research is recommended to improve the matching between the SIRS scoring and each KTAS level to better classify the patient severity status and develop or discover new infection assessment tools that can be applied to KTAS.

Key words: Triage; Systemic inflammatory response syndrome; Leukocytes; Validation studies