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Journal of Neurology

, Volume 266, Issue 11, pp 2685–2698 | Cite as

Development and validation of the Heidelberg Neurological Triage System (HEINTS)

  • Hanna M. Oßwald
  • Linda Harenberg
  • Hannah Jaschonek
  • Sibu Mundiyanapurath
  • Jan C. Purrucker
  • Geraldine Rauch
  • Peter A. Ringleb
  • Simon NagelEmail author
Original Communication
  • 100 Downloads

Abstract

Background/objective

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Triage Neurological emergency Emergency room 

Notes

Acknowledgements

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.

Ethical standards

The study was approved by the institutional review board.

Informed consent

Written informed consent was obtained from the participants (nurses, nurse assistants and physicians working in the emergency room). Patients’ consent was waived.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyHeidelberg University HospitalHeidelbergGermany
  2. 2.Institute of Medical Biometry and InformaticsHeidelberg University HospitalHeidelbergGermany
  3. 3.Institute of Biometry and Clinical EpidemiologyCharité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany

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