評估台灣到院前五級檢傷系統在緊急醫療救護中的有效性：評分者間信度與患者結果預測

Abstract

背景: 臺灣院前五級檢傷系統是一項新開發的檢傷工具，目的為提高院前檢傷的準確性和一致性。相較於過去的二級檢傷系統，臺灣院前五級檢傷系統能更詳細地分類患者的病情嚴重程度。本研究包含兩部分，第一部分評估緊急救護技術員與急診檢傷護理師之間的檢傷一致性。第二部分則是探討臺灣院前五級檢傷系統對病人到急診的院後結果的區分能力。 研究目的: 本研究旨在評估臺灣院前五級檢傷系統在以下兩個方面的臨床效能：（1）緊急救護技術員與急診檢傷護理師之間的檢傷一致性。（2）區分病人到急診的院後結果（如離開急診、住院、死亡及急診停留時間）的能力 方法: 研究一為橫斷性研究，納入10名緊急救護技術員與10名急診檢傷護理師對50個到院前電子病歷進行檢傷，並使用組內相關係數及多層次模型進行分析。研究二為前瞻性世代研究，分析2023年1月至12月期間，在臺灣桃園市由緊急醫療服務運送的10,713名患者。 結果: 研究一顯示，臺灣院前五級檢傷系統在考量多位評分者間的平均分數差異具有卓越的一致性（ICC = 0.96），在考量單一評分者間的絕對分數差異則具有中等一致性（ICC = 0.57）。雖然救護技術員的檢傷分數普遍高於檢傷護理師，但整體一致性仍非常高（r = 0.909）。研究二發現，臺灣院前五級檢傷系統能有效預測急診結果，分數越低的患者死亡率及資源使用需求越高。離開急診病人的中位停留時間為2.73小時，而住院病人則為13.90小時。 結論: 臺灣院前五級檢傷系統是一項可靠且有效的院前檢傷工具，可準確區分急診結果，並在醫療人員之間展現出高度的一致性，整合院前檢傷系統與院內檢傷系統有望優化患者流向及急診資源管理。

Introduction: The five-level Taiwan Prehospital Triage System (TPTS) is a newly developed tool aimed at improving prehospital triage accuracy and consistency. Unlike the previous binary system, 2-level TPTS provides a more detailed categorization of patient severity. Study 1 examined inter-rater reliability among Emergency Medical Technicians (EMTs) and Triage Registered Nurses (TRNs), while Study 2 explored the system's ability to discriminate ability patient outcomes. Aims: This research aims to evaluate the clinical effectiveness of the 5-level TPTS in two key areas: (1)its inter-rater reliability between EMTs and TRNs ; and (2) its ability to discriminate emergency department (ED) outcomes such as discharge, admission, mortality, and length of stay (LOS). Methods: In Study 1 assessed inter-rater reliability through a prospective design involving 10 EMTs and 10 TRNs rating 50 prehospital electronic medical records. Intraclass correlation coefficients (ICCs) and multilevel models were used for analysis. Study 2, prospective cohort study, conducted in Taoyuan, Taiwan, from January 1 to December 31, 2023,analyzed 10,713 EMS-transported patients using the five-level TPTS. Results: Study 1 demonstrated excellent inter-rater reliability for multiple raters (ICC = 0.96) and moderate reliability for single raters (ICC = 0.57). EMTs generally scored higher than TRNs, though agreement was strong overall (r = 0.909). Study 2 revealed that 5-level TPTS effectively discriminated ED outcomes, with lower scores correlating with higher mortality and resource utilization. Discharged patients had a median LOS of 2.73 hours, compared to 13.90 hours for admitted patients. Conclusions: The five-level TPTS is a reliable and effective tool for prehospital triage. It accurately discriminates ED outcomes and demonstrates strong alignment among healthcare providers, making it a valuable addition to emergency medical services. Further integration with hospital triage systems could enhance patient flow and resource management.