Australasian Triage Scale (ATS) is used to prioritize incoming patients in the emergency department (ED) according to patient acuity. It`s a five-level triage scale endorsed by the Australasian College for Emergency Medicine (ACEM). The ATS categories are defined by physiological predictors (airway, breathing, circulation, and disability) and maximum waiting time to treatment (1: immediate, 2: 10 minutes, 3: 30 minutes, 4: 60 minutes and 5: 120 minutes). Triage scales should be valid and reliable to ensure safe practice and promote clinical applicability in ED. Ebrahimi et al. reported that the pooled coefficient for ATS is fair: 0.390 (95% CI 0.307–0.466).

Ebrahimi, Mohsen

Mirhaghi, Amir

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Emergency. 2017; 5 (1): e50LETTER TO EDITORThe Australasian Triage Scale Level 5 Criteria May Need toBe Revised; a CommentaryAmir Mirhaghi1∗, Mohsen Ebrahimi21. Evidence-Based Caring Research Center, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad Universityof Medical Sciences, Mashhad, Iran.2. Department of Emergency Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.Received: March 2016; Accepted: August 2016; Published online: 14 January 2017Cite this article as: Mirhaghi A, Ebrahimi M.The Australasian Triage Scale Level 5 Criteria May Need to Be Revised; a Commentary. Emer-gency. 2017; 5(1): e50.Dear EditorAustralasian Triage Scale (ATS) is used to prioritize incomingpatients in the emergency department (ED) according topatient acuity. It’s a five-level triage scale endorsed by theAustralasian College for Emergency Medicine (ACEM). TheATS categories are defined by physiological predictors (air-way, breathing, circulation, and disability) and maximumwaiting time to treatment (1: immediate, 2: 10 minutes, 3:30 minutes, 4: 60 minutes and 5: 120 minutes) (1). Triagescales should be valid and reliable to ensure safe practiceand promote clinical applicability in ED (2). Ebrahimi et al.reported that the pooled coefficient for ATS is fair: 0.390 (95%CI 0.307–0.466) (3). I’d like to bring your attention to the factthat ATS has used the same criteria for level 4 and 5. Patientswith normal Glasgow coma scale (GCS), patent airway andno respiratory distress and haemodynamic compromise maybe allocated either to level 4 or 5 (1). Therefore, it has to besaid that a source of confusion may exist in ATS level 4 and 5.Studies have also reported that ATS level 5 patients have notbeen recognized accurately and consistently by triage nurses(3, 4), despite the fact that ATS level 5 patient presentationsare less urgent and usually easily distinguishable. However,these kinds of patients are not critically ill, their number isusually higher than patients of other categories and they mayalso be over triaged into upper categories by triage nursesand so urgent patients may encounter significant delay andharm. The reason may lay in adult physiological predictors(APP) in ATS that do not significantly differentiate betweencategory 4 and 5 criteria (1). It’s also worth mentioning thatcontrary to emergency severity scale (ESI), ATS does not have∗Corresponding Author: Amir Mirhaghi; Evidence-Based Caring ResearchCenter, Department of Medical-Surgical Nursing, School of Nursing and Mid-wifery, Mashhad, Iran. Email: mirhaghia@mums.ac.ir .a tendency to allocate patients into a specific category (5).A recent study on validity and reliability of ATS has reportedan overall inter-rater agreement of 0.40 using Fleiss’ kappacoefficient, representing a fair-to-good level of inter-rateragreement, as well as the fact that the lowest coefficient ofreliability belongs to level 5 (0.47) (4). Although, 65% of theparticipant responses to all triage scenarios were accurate,only 40% of triage decisions in level 5 has been accurate,representing the least value among triage categories (4).Therefore, fair consistency and low accuracy in category 5raises serious questions that category 5 criteria may lacksufficient clarity, precision or accuracy. Finally, since ATSneeds to be modified periodically, like any other triage scale(6), it’s recommended that level 5 criteria should be revisedto ensure safe practice in ED.References1. Aging DoHa. Emergency Triage Educa-tion Kit: workbook 2009. Available from:http://www.health.gov.au/internet/main/publishing.nsf/Content/casemix-ED-triage+Review+Fact+Sheet+Documents.2. Esmailian M, Zamani M, Azadi F, Ghasemi F. Inter-rater agreement of emergency nurses and physiciansin Emergency Severity Index (ESI) triage. Emergency.2014;2(4):158.3. Ebrahimi M, Heydari A, Mazlom R, Mirhaghi A. The reli-ability of the Australasian Triage Scale: a meta-analysis.World J Emerg Med. 2015;6(2):94-9.4. Ekins K, Morphet J. The accuracy and consistency of rural,remote and outpost triage nurse decision making in oneWestern Australia Country Health Service Region. Aus-tralasian Emergency Nursing Journal. 2015;18(4):227-33.This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jemerg.comA. Mirhaghi and M. Ebrahimi. 25. Mirhaghi A, Kooshiar H, Esmaeili H, Ebrahimi M. Out-comes for emergency severity index triage implementa-tion in the emergency department. Journal of clinical anddiagnostic research: JCDR. 2015;9(4):OC04.6. Considine J, Shaban RZ, FitzGerald GJ, Thomas S, GrahamCA. Triage and ATS: Collateral damage in the quest to im-prove ED performance. Australasian Emergency NursingJournal. 2012;15(4):185-7.This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jemerg.com

The Australasian Triage Scale Level 5 Criteria may Need to be Revised

Australasian Triage Scale (ATS) is used to prioritize incoming patients in the emergency department (ED) according to patient acuity. It`s a five-level triage scale endorsed by the Australasian College for Emergency Medicine (ACEM). The ATS categories are defined by physiological predictors (airway, breathing, circulation, and disability) and maximum waiting time to treatment (1: immediate, 2: 10 minutes, 3: 30 minutes, 4: 60 minutes and 5: 120 minutes). Triage scales should be valid and reliable to ensure safe practice and promote clinical applicability in ED. Ebrahimi et al. reported that the pooled coefficient for ATS is fair: 0.390 (95% CI 0.307–0.466). </p

The Australasian Triage Scale Level 5 Criteria may Need to be Revised

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