三区四级分诊标准在急诊中的信效度评价：一项1106例急诊成人患者的随机抽样横断面研究  

Reliability and validity of four-level and three-district triage standards in emergency department： a randomized sampling cross-sectional study of 1 106 adult patients

作　　者：朱爱群[1,2] 张静平[2] 张慧琳[1] 张艳辉[1] 

机构地区：[1]中南大学湘雅二医院急诊科,湖南长沙410011 [2]中南大学湘雅护理学院,湖南长沙410013

出　　处：《中华危重病急救医学》2017年第5期453-458,共6页Chinese Critical Care Medicine

基　　金：湖南省科技计划项目（2015SK2028）

摘　　要：目的评价三区四级分诊标准在成人急诊中的信效度。方法采用随机抽样横断面研究方法，选择2015年12月至2016年4月湖南省湘雅二医院急诊科收治的1106例成人急诊患者。由12名护士应用国家卫生和计划生育委员会三区四级分诊标准对急诊患者进行分诊。依据随机排班方式，每班各安排2名护士分别作为分诊指导者和分诊协助者，对每位患者进行独立分诊；收集患者一般资料、急诊资料（入急诊时间、方式、主诉、生命体征和意识状态）、分诊资料（分诊级别、分诊科室）、医生接诊时间（即候诊时间）、处理时间、去向和结局。通过Spearman相关分析评价三区四级分诊标准的信度；绘制受试者工作特征曲线（ROC），评价三区四级分诊标准的效度。结果①研究初期2周共纳入254例患者进行信度评价，分诊指导组与分诊协助组护士分诊结果的总体内部一致率为72％，总体一致性K印pa值为0．686[95％可信区间（95％CI）：0．608—0．757，．P〈0．001]。②效度分析结果显示：共1125例患者在研究期间于急诊科就诊，排除不配合或拒绝治疗、资料不完整及院前死亡患者后，共1106例患者纳入分析。随三区四级分诊级别升高，患者候诊时间、处理时间延长，留观率升高，抢救率及住院率降低，住院时间缩短，急诊病死率、住院病死率和总病死率降低[分诊1—4级患者候诊时间（min）：1．00（1．00，1．75）、1．00（1．00，5．00）、8．00（2．00，23．00）、10．00（4．50，28．00），处理时间（min）：1．00（1．00，10．00）、6．00（1．00，23．00）、48．00（25．00，105．00）、87．00（41．00，140．00），留观率：4．76％、10．94％、55．91％、42．86％，抢救率：95．24％、87．94％、20．81％、0％，住院率：57．14％、70．98％、53．62％、20．41％，住院时间（d）：19．50（9．75�Objective To evaluate the reliability and validity of three-district and four-level triage standards in adult emergency department. Methods A randomized sampling cross-sectional study was conducted. A total of 1 106 emergency adult patients admitted to the Second Xiangya Hospital of Central South University in Hunan Province from December 2015 to April 2016 were enrolled. The triage was independently performed by 12 nurses according to the emergency triage criteria. Based on the shift style, 2 nurses were assigned to each shift as the triage guider and assistant respectively, who did the triage for every patient independently. The clinical data were recorded as follows： the demographic data, emergency information （triage time, emergency way, complaints, vital signs, and conscious state）, triage information （triage level, admitted department）, waiting time, treatment time, destination and outcomes. The reliability of three-district and four-level triage standards was analyzed by Spearman correlation, and the receiver operating characteristic curve （ROC） was plotted to evaluate its validity. Results （1） A total of 254 patients were enrolled for reliability evaluation in the first 2 weeks of the study. The overall internal consistency rate of the triage instructors and the triage assistants was 72%, the total Kappa value was 0.686 [95% confidence interval （95%CI） = 0.608-0.757, P 〈 0.001]. （2） Validity analysis showed that in the 1 125 emergency patients collected during the study, a total of 1 106 patients were finally enrolled in the analysis excluding the patients who refused to accept the treatment, whose data was incomplete and who was diagnosed as prehospital death. With the increase of three-district and four-level triage level, a significant increase was showed in the waiting time of patients, the treatment time, and the retention rate; on the contrary, the salvage rate, the hospitalization rate, hospitalization time, emergency mortality, in-hospital mortality and total mortality

关 键 词：急诊 二三区四级分诊标准 信度 效度 

分 类 号：R459.7[医药卫生—急诊医学]