Validation of The Cipto Triage Method: a single-centre study from Indonesia.

Abstract

Background A national referral hospital in Indonesia developed a three-category triage acuity method called the Cipto Triage Method (CTM) for emergency departments (ED) in developing countries. This was a validation study to assess the performance of the triage method.Methods This cohort, retrospective, single-centre study was conducted in the ED of Cipto Mangunkusumo Hospital that receives approximately 30,000 patient visits per year. The ED medical records throughout the year 2017 were randomly selected as the study sample. Completely written forms of triage and ED initial assessment were included in this study. Validation of the CTM decision was done by using expert panel opinion as reference standard, and also using surrogate conditions such as patient outcome for hospital admission and in-hospital mortality.Results There were 1,348 samples assigned to the following three categories: resuscitation (14.9%), urgent (63.8%) and non- urgent (21.3%). Overall accuracy was more than 80%, positive predictive value (PPV) and negative predictive value (NPV) for resuscitation category were 99% (95% confident interval [CI], 96.5-99.9) and 96.9% (95% CI, 95.7 -97.8), respectively. Resuscitation category had a relative risk (RR) for admission of 1.341 (95% CI, 1.259-1.429) and a RR for mortality of 4.294 (95%CI, 3.180-5.799). Undertriage increases the risk of mortality compared to correct triage (RR, 3.1; 95% CI, 2.11-4.54)Conclusion CTM has a good criterion and construct validity; it is also easy to understand and can accommodate a simple ED design in the majority of hospitals in Indonesia.

State of emergency medicine in Indonesia

“…conclude that there is neither consensus among hospitals nor any government regulation with regards to an Indonesian triage protocol. Most of the hospitals implement a coloured triage system, which is typically used during a period of calamity – only a few hospitals, such as Cipto Mangunkusumo General Hospital, have adopted the Australasian Triage Scale …”