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Association between initial presenting level of consciousness and patient acuity – A potential application for secondary triage in emergency ambulance calls

  • Jason Belcher
    Correspondence
    Correspondence to: Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, GPO Box U1987, Perth 6845, Western Australia, Australia.
    Affiliations
    Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Perth, Western Australia, Australia

    St John Western Australia, Australia
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  • Judith Finn
    Affiliations
    Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Perth, Western Australia, Australia

    St John Western Australia, Australia
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  • Austin Whiteside
    Affiliations
    Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Perth, Western Australia, Australia

    St John Western Australia, Australia
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  • Stephen Ball
    Affiliations
    Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Perth, Western Australia, Australia

    St John Western Australia, Australia
    Search for articles by this author
Published:December 07, 2022DOI:https://doi.org/10.1016/j.auec.2022.11.002

      Abstract

      Introduction

      Conscious state assessment is important for the triage of emergency patients. In this study, we measured the association between ambulance patients’ conscious state and high versus lower acuity, with a view to informing telephone triage assessment of conscious state.

      Methods

      Data were analysed from one year of emergency ambulance incidents in Perth, Western Australia. Patient conscious state at the time of paramedic arrival was compared to acuity (based on paramedic assessment and management). We determined the proportion of high-acuity patients across six levels of consciousness (Alert, Confused, Drowsy, Voice Response, Pain Response, Unresponsive) overall, and within individual protocols of the Medical Priority Dispatch System (MPDS).

      Results

      The proportion of high acuity patients increased with each step across the consciousness scale. Applying conscious state as a binary predictor of acuity, the largest increases occurred moving the threshold from Alert to Confused (22.0–48.6% high acuity) and Drowsy to Voice Response (61.9–89.5% high acuity). The Area Under the Curve (AUC) of the Receiver Operating Characteristic was 0.65. Within individual protocols, the highest AUC was in Cardiac Arrest (0.89), Overdose/Poisoning (0.81), Unknown Problem (0.76), Diabetic Problem, (0.74) and Convulsions/Fitting (0.73); and lowest in Heart problems (0.55), Abdominal Pain (0.55), Breathing Problems (0.55), Back Pain (0.53), and Chest Pain (0.52).

      Conclusion

      Based on these proportions of high acuity patients, it is reasonable to consider patients with any altered conscious state a high priority. The value of conscious state assessment for predicting acuity varies markedly between MPDS protocols. These findings could help inform secondary triage of ambulance patients during the emergency call.

      Keywords

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