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Emerg Med J. 2013 Jun;30(6):454-8. doi: 10.1136/emermed-2012-201423. Epub 2012 Jun 26.

Validity of a computerised five-level emergency triage system for patients with acute ischaemic stroke.

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  • 1Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.



An ideal triage system used in the emergency department (ED) should identify patients who need urgent medical care. The purpose of this study was to validate the Taiwan Triage and Acuity Scale (TTAS) for stratifying patients according to their severity, need for thrombolysis, resource utilisation, and outcome.


The authors retrospectively reviewed all admitted patients with a discharge diagnosis of acute ischaemic stroke from January 2010 to September 2011. Presenting complaints, activation of code stroke protocol, eligibility of intravenous tissue plasminogen activator treatment, time from ED arrival to treatment, and outcome at discharge were compared by the five-level triage system.


Of 706 enrolled patients (level 1, 55; level 2, 455; level 3, 192; level 4, 4; level 5, 0), there were 412 (58.4%) men and 294 women (41.6%), with a mean age of 69.4 years. The initial stroke severity, time from onset to arrival, time from arrival to imaging, proportion of patients for whom code stroke protocol was activated, length of hospital stay, and good functional outcome at discharge correlated with TTAS levels. A total of 84 patients were thrombolysis candidates, and 98.8% of them were designated as either level 1 or level 2. For those treated with thrombolytic therapy (n=47), the time from arrival to thrombolysis was not significantly different between TTAS level 1 and 2.


Acuity measured by the computerised TTAS demonstrated good validity in facilitating acute care of stroke patients with special regard to thrombolytic therapy.


COPD; Stroke; clinical; neurology; research; respiratory; thrombolysis; triage

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