Impact of Pain Assessment on Canadian Triage and Acuity Scale Prediction of Patient Outcomes

How does the removal of patient-reported pain from the Canadian Triage Acuity Scale (CTAS) affect the scale’s ability to predict admission, ICU consultation, and mortality? Retrospective observational cohort study of all adult visits to a tertiary emergency department. The standard CTAS algorithm co...

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Published inAnnals of emergency medicine Vol. 79; no. 5; pp. 433 - 440
Main Authors Davis, Seth, Ju, Chelsey, Marchandise, Philippe, Diagne, Magueye, Grant, Lars
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.05.2022
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Abstract How does the removal of patient-reported pain from the Canadian Triage Acuity Scale (CTAS) affect the scale’s ability to predict admission, ICU consultation, and mortality? Retrospective observational cohort study of all adult visits to a tertiary emergency department. The standard CTAS algorithm combined patient-reported pain levels with other data to generate a triage score for each visit. We calculated a “pain-free” CTAS for each visit in the cohort, assuming that the patient had not reported any pain. We fit logistic regression models for each outcome (admission, ICU consultation, and mortality) using either the standard or the pain-free CTAS as the predictor. We compared the area under the receiver operator characteristic curves of the standard versus pain-free CTAS models for each outcome. We analyzed a sample of 229,744 patients. The average reported pain level was 5.6/10 (SD, 3.0) among the 60.1% of the cohort who reported pain. Higher pain was slightly negatively correlated with hospital admission, ICU consultation, and 72-hour mortality (r = −0.008, −0.009, and −0.006, respectively). The area under the curve of the pain-free CTAS was higher than that of the standard scores for hospital admission (0.691 versus 0.641), ICU consultation (0.829 versus 0.773), and mortality (0.863 versus 0.810). Differences were statistically but not clinically significant. The removal of the pain scale from CTAS did not reduce its ability to predict hospital admission, ICU consultation, or the 72-hour mortality.
AbstractList STUDY OBJECTIVEHow does the removal of patient-reported pain from the Canadian Triage Acuity Scale (CTAS) affect the scale's ability to predict admission, ICU consultation, and mortality? METHODSRetrospective observational cohort study of all adult visits to a tertiary emergency department. The standard CTAS algorithm combined patient-reported pain levels with other data to generate a triage score for each visit. We calculated a "pain-free" CTAS for each visit in the cohort, assuming that the patient had not reported any pain. We fit logistic regression models for each outcome (admission, ICU consultation, and mortality) using either the standard or the pain-free CTAS as the predictor. We compared the area under the receiver operator characteristic curves of the standard versus pain-free CTAS models for each outcome. RESULTSWe analyzed a sample of 229,744 patients. The average reported pain level was 5.6/10 (SD, 3.0) among the 60.1% of the cohort who reported pain. Higher pain was slightly negatively correlated with hospital admission, ICU consultation, and 72-hour mortality (r = -0.008, -0.009, and -0.006, respectively). The area under the curve of the pain-free CTAS was higher than that of the standard scores for hospital admission (0.691 versus 0.641), ICU consultation (0.829 versus 0.773), and mortality (0.863 versus 0.810). Differences were statistically but not clinically significant. CONCLUSIONThe removal of the pain scale from CTAS did not reduce its ability to predict hospital admission, ICU consultation, or the 72-hour mortality.
How does the removal of patient-reported pain from the Canadian Triage Acuity Scale (CTAS) affect the scale's ability to predict admission, ICU consultation, and mortality? Retrospective observational cohort study of all adult visits to a tertiary emergency department. The standard CTAS algorithm combined patient-reported pain levels with other data to generate a triage score for each visit. We calculated a "pain-free" CTAS for each visit in the cohort, assuming that the patient had not reported any pain. We fit logistic regression models for each outcome (admission, ICU consultation, and mortality) using either the standard or the pain-free CTAS as the predictor. We compared the area under the receiver operator characteristic curves of the standard versus pain-free CTAS models for each outcome. We analyzed a sample of 229,744 patients. The average reported pain level was 5.6/10 (SD, 3.0) among the 60.1% of the cohort who reported pain. Higher pain was slightly negatively correlated with hospital admission, ICU consultation, and 72-hour mortality (r = -0.008, -0.009, and -0.006, respectively). The area under the curve of the pain-free CTAS was higher than that of the standard scores for hospital admission (0.691 versus 0.641), ICU consultation (0.829 versus 0.773), and mortality (0.863 versus 0.810). Differences were statistically but not clinically significant. The removal of the pain scale from CTAS did not reduce its ability to predict hospital admission, ICU consultation, or the 72-hour mortality.
How does the removal of patient-reported pain from the Canadian Triage Acuity Scale (CTAS) affect the scale’s ability to predict admission, ICU consultation, and mortality? Retrospective observational cohort study of all adult visits to a tertiary emergency department. The standard CTAS algorithm combined patient-reported pain levels with other data to generate a triage score for each visit. We calculated a “pain-free” CTAS for each visit in the cohort, assuming that the patient had not reported any pain. We fit logistic regression models for each outcome (admission, ICU consultation, and mortality) using either the standard or the pain-free CTAS as the predictor. We compared the area under the receiver operator characteristic curves of the standard versus pain-free CTAS models for each outcome. We analyzed a sample of 229,744 patients. The average reported pain level was 5.6/10 (SD, 3.0) among the 60.1% of the cohort who reported pain. Higher pain was slightly negatively correlated with hospital admission, ICU consultation, and 72-hour mortality (r = −0.008, −0.009, and −0.006, respectively). The area under the curve of the pain-free CTAS was higher than that of the standard scores for hospital admission (0.691 versus 0.641), ICU consultation (0.829 versus 0.773), and mortality (0.863 versus 0.810). Differences were statistically but not clinically significant. The removal of the pain scale from CTAS did not reduce its ability to predict hospital admission, ICU consultation, or the 72-hour mortality.
Author Davis, Seth
Marchandise, Philippe
Ju, Chelsey
Grant, Lars
Diagne, Magueye
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CitedBy_id crossref_primary_10_3390_jpm14020195
crossref_primary_10_1186_s13049_023_01130_9
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Snippet How does the removal of patient-reported pain from the Canadian Triage Acuity Scale (CTAS) affect the scale’s ability to predict admission, ICU consultation,...
How does the removal of patient-reported pain from the Canadian Triage Acuity Scale (CTAS) affect the scale's ability to predict admission, ICU consultation,...
STUDY OBJECTIVEHow does the removal of patient-reported pain from the Canadian Triage Acuity Scale (CTAS) affect the scale's ability to predict admission, ICU...
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StartPage 433
Title Impact of Pain Assessment on Canadian Triage and Acuity Scale Prediction of Patient Outcomes
URI https://dx.doi.org/10.1016/j.annemergmed.2022.01.014
https://www.ncbi.nlm.nih.gov/pubmed/35184870
https://search.proquest.com/docview/2631629910
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