Development and validation of the Heidelberg Neurological Triage System (HEINTS)
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Neurological syndromes are underrepresented in existing triage systems which are not validated for neurological patients; therefore, we developed and validated the new Heidelberg Neurological Triage System (HEINTS) in a prospective, single-center observational study.
Patients were triaged according to the new triage system by nurses and physicians (stage 1) as well as trained nurses (stage 2). In stage 1, all patients presenting to the neurological emergency room (ER) were triaged by nurses and physicians. In stage 2, three specially trained nurses triaged patients according to HEINTS. The main outcomes comprised interrater agreement between nurses’ and physicians’ triage (stage 1), sensitivity and specificity to detect emergencies (stages 1 and 2), and improvement in triage quality as a result of training (stage 2), as well as correlation of HEINTS with hospital admissions and resource utilization.
In stage 1 (n = 2423 patients), sensitivity and specificity to detect neurological emergencies were 84.2% (SD 0.8%) and 85.4% (SD 0.8%) for nurses, as well as 92.4% (SD 0.6%) and 84.1% (SD 0.9%) for physicians, respectively. The interrater-reliability between nurses and physicians in stage 1 was moderate [Cohen’s kappa 0.44, standard deviation (SD) 0.02]. In stage 2 (n = 506 patients), sensitivity of trained nurses increased to 94.3% (SD 1.0%), while specificity decreased to 74.8% (SD 1.9%). Correlation of HEINTS triage with hospital admission and resource utilization in both stages was highly significant.
HEINTS predicted hospital admissions and resource utilization. Agreement between nurses and physicians was moderate. HEINTS, applied by physicians and by nurses after training, reliably detected neurological emergencies.
KeywordsTriage Neurological emergency Emergency room
We thank all our nurses’ and physicians’ staff for their participation and support in realizing this study. Special thanks goes to Ann-Christin Butke, Lena Kleebauer and Ulrike Weiß for their dedication to the project.
Compliance with ethical standards
Conflicts of interest
Dr. Oßwald, Mrs. Harenberg, Dr. Jaschonek, Dr. Mundiyanapurath, and Prof. Rauch have nothing to disclose. Dr. Purrucker reports personal fees from BMS Pfizer, Boehringer Ingelheim and Akcea, outside the submitted work. Dr. Ringleb reports personal fees from Bayer, BMS Pfizer, Boehringer Ingelheim, Grants from Deutsche Forschungsgemeinschaft, outside the submitted work. Dr. Nagel reports personal fees from Brainomix, BMS Pfizer, Boehringer Ingelheim and Medtronic, outside the submitted work.
The study was approved by the institutional review board.
Written informed consent was obtained from the participants (nurses, nurse assistants and physicians working in the emergency room). Patients’ consent was waived.
- 4.Gumbinger C, Reuter B, Stock C et al (2014) Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice: retrospective analysis of hospital quality assurance data with comparison with results from randomised clinical trials. BMJ 348:g3429CrossRefGoogle Scholar
- 7.Auburtin M, Wolff M, Charpentier J et al (2006) Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: the PNEUMOREA prospective multicenter study. Crit Care Med 34:2758–2765CrossRefGoogle Scholar
- 17.Grossmann FF, Zumbrunn T, Frauchiger A, Delport K, Bingisser R, Nickel CH (2012) At risk of undertriage? Testing the performance and accuracy of the emergency severity index in older emergency department patients. Ann Emerg Med 60(317–25):e3Google Scholar
- 20.Berchet C (2015) Emergency care services: trends, drivers and interventions to manage the demand. OECD Health Working Papers, no. 83. OECD Publishing, ParisGoogle Scholar
- 22.Gilboy NTT, Travers D, Rosenau AM (2011) Emergency Severity Index (ESI): a triage tool for emergency department care, version 4. implementation handbook, 2012nd edn. Agency for Healthcare Research and Quality, RockvilleGoogle Scholar
- 33.Ebrahimi M, Mirhaghi A, Mazlom R, Heydari A, Nassehi A, Jafari M (2016) The role descriptions of triage nurse in emergency department: a Delphi study. Scientifica (Cairo) 2016:5269815Google Scholar