Predictability of the emergency department triage system during the COVID-19 pandemic.

Background:Emergency department (ED) triage systems are used to classify the severity and urgency of emergency patients, and Korean medical institutions use the Korean Triage and Acuity Scale (KTAS). During the coronavirus disease 2019 (COVID-19) pandemic, appropriate treatment for emergency patients was delayed due to various circumstances, such as overcrowding of EDs, lack of medical workforce resources, and increased workload on medical staff. The purpose of this study was to evaluate the accuracy of the KTAS in predicting the urgency of emergency patients during the COVID-19 pandemic. Methods:This study retrospectively reviewed patients who were treated in the ED during the pandemic period from January 2020 to June 2021. Patients were divided into COVID-19 screening-negative (SN group) and COVID-19 screening-positive (SP group) groups. We compared the predictability of the KTAS for urgent patients between the two groups. Results:Of 107,480 patients, the SN and SP groups included 62,776 (58.4%) and 44,704 (41.6%) patients, respectively. The odds ratios for severity variables at each KTAS level revealed a more evident discriminatory power of KTAS for severity variables in the SN group (p-value <0.001). The predictability of KTAS for severity variables was higher in the SN group than in the SP group (area under the curve, p-value <0.001). Conclusion:During the pandemic, the KTAS had low accuracy in predicting patients in critical conditions in the ED. Therefore, in future pandemic periods, supplementation of the current ED triage system should be considered in order to accurately classify the severity of patients.