Amir Mirhaghi

ACTA MEDICA IRANICA

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 LETTER TO THE EDITOR   Corresponding Author: A. Mirhaghi Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran Tel: +98 5138591511, Fax: +98 5138597313, E-mail address: Mirhaghia@mums.ac.ir  Vital Sign Assessment Directives Have Not Associated With Diagnostic Validity  Amir Mirhaghi1,2 1 Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran 2 Evidence-Based Caring Research Center, Mashhad University of Medical Sciences, Mashhad, Iran  Received: 18 Sep. 2016; Received in revised form: 13 Jan. 2017; Accepted: 31 Jan. 2017  With great interest, we have read the notable publication in the recent Acta Medica Iranica from Hosein Nejad et al., entitled “Evaluation of the Significance of Vital Signs in the Up-Triage of Patients Visiting Emergency Department from Emergency Severity Index Level 3 to 2” (1). We would like to bring your attention to the discrepancy regarding the overall conclusion of the study on the directive for using vital signs in triage decision making. Authors indicated that heart rate (HR) and respiratory rate (RR) have stronger contribution to up-triage of level III patients than O2 saturation, so they suggested that RR should be measured first in level III patients and secondly HR should be measured if RR is within normal ranges and even the omission of the O2 saturation criteria in the case of severe overcrowding of the emergency department.  First of all, however, it has been well documented that respiratory rate correlates poorly with oxygen saturation (2), these findings do not degrade the significance of peripheral capillary oxygen saturation (O2 saturation). Peripheral capillary oxygen saturation (SpO2) saturation is an indicator for the partial pressure of oxygen (PaO2) criteria. The SpO2 measurement is easy, rapid and invasive and in contrast with RR measurement, SpO2 do not accompany by the higher coefficient of variance, inaccuracy, poor interobserver agreement, and low variability of routine measurements in clinical practice (3,4,5). Therefore it does not seem appropriate to downgrade the SpO2 measurement especially in triage room that is highly dependent on tools for rapid measurement in the case of severe overcrowding. Secondly, any recommendation for vital signs measurement in triage must be justified based on diagnostic validity methodology. The association between vital signs criteria and mortality or morbidity must be accounted for any supplementary directives (6,7). Therefore, the study has not been fully prepared to jump to conclusion. Apart from this point, the study must have used inferential statistics in order to reach any form of judgment. However emergency severity index triage system has shown an acceptable level of reliability and validity (8), further studies were recommended to adopt the ESI efficiently.  References  1. Hossein Nejad H, Banaie M, Seyedhosseini, Davarani SH, Khazaeipour Z. Evaluation of the Significance of Vital Signs in the Up-Triage of Patients Visiting Emergency Department from Emergency Severity Index Level 3 to 2. Acta Med Iran 2016;54:366-9. 2. Mower WR, Sachs C, Nicklin EL, Safa P, Baraff LJ. A comparison of pulse oximetry and respiratory rate in patient screening. Respir Med 1996;90:593-9. 3. Mirhaghi A, Christ M. Revision for the Rapid Emergency Triage and Treatment System Adult (RETTS-A) needed? Scand J Trauma Resusc Emerg Med. 2016 Apr 26;24:55. 4. Lovett PB, Buchwald JM, Stürmann K, Bijur P. The vexatious vital: neither clinical measurements by nurses nor an electronic monitor provides accurate measurements of respiratory rate in triage. Ann Emerg Med 2005;45:68-76. 5. Bianchi W, Dugas AF, Hsieh YH, Saheed M, Hill P, Lindauer C, et al. Revitalizing a vital sign: improving detection of tachypnea at primary triage. Ann Emerg Med 2013;61:37-43. 6. Gunaydin YK, Çağlar A, Kokulu K, Yıldız CG, Dündar ZD, Akilli NB, et al. Triage using the Emergency Severity Index (ESI) and seven versus three vital signs. Notf Rettungsmed 2016;19:209-16. 7. Mirhaghi A, Christ M. The conclusion validity of the triage scales has been threatened. Notfall + Rettungsmedizin 2016;19:299-300. 8. Mirhaghi A, Kooshiar H, Esmaeili H, Ebrahimi M. Outcomes for Emergency Severity Index Triage implementation in the Emergency Department. J Clin Diagn Res 2015;9:OC04-7. 

Vital Sign Assessment Directives Have Not Associated With Diagnostic Validity

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