Validation of the Cipto Triage Method: A Single-Centre Study from Indonesia

Figures & data

Table 1 Characteristic of ED Patients

Demography	N (%)
Sex
Male	742 (55)
Female	606 (45)
Total	1348
Age interval
0−28 days	21 (1.5)
>28 days−18 years old	323 (24)
>18−60 years old	734 (54.5)
>60 years old	270 (20)
Total	1348
Trauma related
Yes	215 (15.9)
No	1132 (84.1)
Actual triage levels
Resuscitation	201 (14.9)
Urgent	860 (63.8)
Non-urgent	287 (21.3)
Hospital admission
Yes	940 (69.7)
No	404 (29.9)
Dead on arrival	4 (0.4)
In-hospital mortality
Yes	139 (10.3)
No	1205 (89.4)
Dead	4 (0.3)

Table 2 Distribution of Triage Decision Using Cipto Triage Method Based on Panel Judgement and Triage Officer and Its Accuracy

Categories	Panel Judgement			Total	Accuracy(%)	95% CI
Triage Officer	Resuscitation	Urgent	Non-Urgent
Resuscitation	199	2	0	201	97.2	96.3–98.1
Urgent	34	716	110	860	88.1	86.3–89.8
Non-urgent	2	15	270	287	90.6	89.0–92.1
Total	235	733	380	1348
Overall undertriage					5.6	4.3–6.8
Overall overtriage					8.3	6.8–9.7

Abbreviation: CI, confidence interval

Table 3 Diagnostic Performance of CTM (Criterion Validity)

Triage Category	Results	95% CI
Resuscitation
Sensitivity (%)	84.7	79.4 −89
Specificity (%)	99.8	99.4 −100
PPV (%)	99	96.5 −99.9
NPV (%)	96.9	95.7 −97.8
LR+	471	118 −1884
LR-	0.153	0.11 −0.21
Non-urgent
Sensitivity (%)	71.1	66.2 −75.6
Specificity (%)	98.2	97.2 −99
PPV (%)	94.1	90.7 −96.5
NPV (%)	89.6	87.6 −91.4
LR+	40.5	25.1 −65.1
LR-	0.29	0.25 −0.34

Abbreviations: PPV, positive predictive value; NPV, negative predictive value; LR+, positive likelihood ratio; LR-, negative likelihood ratio; CI, confidence interval.

Table 4 Construct Validity of Triage Category Compared to the Risk of Admission and in-Hospital Mortality

Triage Category	Hospital Admission	Relative Risk for Admission	In-Hospital Mortality	Relative Risk of in-Hospital Mortality
Resuscitation	176 (18.7%)	1.341(95% CI, 1.259 −1.429)	59 (42.4%)	4.294 (95% CI, 3.180 −5.799)
Urgent	664 (70.6%)	1.354 (95% CI, 1.243–1.475)	76 (54.7%)	0.679 (95% CI, 0.496 −0.930)
Non-urgent	100 (10.7%)	0.438 (95% CI 0.373–0.515)	4 (2.9%)	0.109 (95% CI, 0.041 −0.292)

Abbreviation: CI, confidence interval.