Article Data

  • Views 811
  • Dowloads 136

Original Research

Open Access

Comparison of validity of Korean triage and acuity scale levels assessed by triage nurse in real-time and by retrospectively applying strict systemic inflammatory response syndrome criteria in patients with fever

  • Heajin Chung1,2
  • David Samuel Kwak3
  • Joonbum Park1,*,

1Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, 04401 Seoul, Republic of Korea

2Kangwon National University Graduate School, 24341 Gangwon-do, Republic of Korea

3Department of Family Medicine, Soonchunhyang University Seoul Hospital, 04401 Seoul, Republic of Korea

DOI: 10.22514/sv.2024.040 Vol.20,Issue 4,April 2024 pp.39-45

Submitted: 03 August 2023 Accepted: 21 September 2023

Published: 08 April 2024

*Corresponding Author(s): Joonbum Park E-mail:


The strict application of vital signs has substantial risk of over-triage. Therefore, this study assessed the predictive value of Korean Triage and Acuity Scale (KTAS) level calculated using strict Systemic Inflammatory Response Syndrome (SIRS) criteria versus that evaluated by a verified triage nurse (TN). The study is based on a retrospective observational cohort of a single-center emergency department (ED) from 01 May 2018 to 30 April 2019. Study subjects were patients aged ≥18 years with fever. Intensive care unit admission rate or death in ED (IADE) and general ward admission rate according to two differently defined KTAS levels were compared by receiver operating characteristic curve and logistic regression. A total of 2322 patients were included. In comparing the area under the curves (AUCs) of TN- and SIRS-KTAS, TN-KTAS’ predictive power for IADE (0.802) was higher than that of SIRS-KTAS (0.7440, p = 0.0489). The odds ratio of level 3 for IADE (1.35) was not significantly different from that of level 4 in SIRS-KTAS (p = 0.5429). In KTAS, the severity of illness in patients was more accurately predicted by the triage nurse’s decision based on clinical experience than the strict application of SIRS criteria with only vital signs.


Emergency service; Triage; Systemic inflammatory response syndrome; Patient acuity; Patient safety; Hospitalization

Cite and Share

Heajin Chung,David Samuel Kwak,Joonbum Park. Comparison of validity of Korean triage and acuity scale levels assessed by triage nurse in real-time and by retrospectively applying strict systemic inflammatory response syndrome criteria in patients with fever. Signa Vitae. 2024. 20(4);39-45.


[1] Iserson KV. Ethics, personal responsibility and the pandemic: a new triage paradigm. The Journal of Emergency Medicine. 2022; 62: 508–512.

[2] Ennis JS, Riggan KA, Nguyen NV, Kramer DB, Smith AK, Sulmasy DP, et al. Triage procedures for critical care resource allocation during scarcity. JAMA Network Open. 2023; 6: e2329688.

[3] Heslin SM, Viccellio P. Overcrowding, triage, and care rationing. Urban Emergency Medicine (pp. 184–190). 1st edition. Cambridge University Press: United of Kingdom. 2023.

[4] AlShatarat M, Rayan A, Eshah NF, Baqeas MH, Jaber MJ, ALBashtawy M. Triage knowledge and practice and associated factors among emergency department nurses. SAGE Open Nursing. 2022; 8: 237796082211305.

[5] Park J, Lim T. Korean triage and acuity scale (KTAS). Journal of The Korean Society of Emergency Medicine. 2017; 28: 547–551.

[6] Beveridge R. The Canadian emergency department triage and acuity scale: a new and critical element in health care reform. Journal of Emergency Medicine. 1998; 16: 507–511.

[7] Gando S, Shiraishi A, Abe T, Kushimoto S, Mayumi T, Fujishima S, et al. The SIRS criteria have better performance for predicting infection than qSOFA scores in the emergency department. Scientific Reports. 2020; 10: 8095.

[8] Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992; 101: 1644–1655.

[9] Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine. 2021; 47: 1181–1247.

[10] Sun J, Chung H, Jang H, Kim S, Lee Y, Park J. Validation of systemic inflammatory response syndrome criteria without white blood cell count in Korean triage and acuity scale. Journal of The Korean Society of Emergency Medicine. 2019; 30: 232–238.

[11] Lee B, Kim DK, Park JD, Kwak YH. Clinical considerations when applying vital signs in pediatric Korean triage and acuity scale. Journal of Korean Medical Science. 2017; 32: 1702.

[12] Moon S-H, Shim JL, Park K-S, Park CS. Triage accuracy and causes of mistriage using the Korean triage and acuity scale. PLOS ONE. 2019; 14: e0216972.

[13] Levis-Elmelech T, Schwartz D, Bitan Y. The effect of emergency department nurse experience on triage decision making. Human Factors in Healthcare. 2022; 2: 100015.

[14] Hwang S, Shin S. Factors affecting triage competence among emergency room nurses: a cross‐sectional study. Journal of Clinical Nursing. 2023; 32: 3589–3598.

[15] Lee JY, Oh SH, Peck EH, Lee JM, Park KN, Kim SH, et al. The validity of the Canadian triage and acuity scale in predicting resource utilization and the need for immediate life-saving interventions in elderly emergency department patients. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2011; 19: 68.

[16] Usman OA, Usman AA, Ward MA. Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department. The American Journal of Emergency Medicine. 2019; 37: 1490–1497.

[17] Oduncu AF, Kıyan GS, Yalçınlı S. Comparison of qSOFA, SIRS, and NEWS scoring systems for diagnosis, mortality, and morbidity of sepsis in emergency department. The American Journal of Emergency Medicine. 2021; 48: 54–59.

[18] Ruangsomboon O, Boonmee P, Limsuwat C, Chakorn T, Monsomboon A. The utility of the rapid emergency medicine score (REMS) compared with SIRS, qSOFA and NEWS for predicting in-hospital mortality among patients with suspicion of sepsis in an emergency department. BMC Emergency Medicine. 2021; 21: 2.

[19] Wang C, Xu R, Zeng Y, Zhao Y, Hu X. A comparison of qSOFA, SIRS and NEWS in predicting the accuracy of mortality in patients with suspected sepsis: a meta-analysis. PLOS ONE. 2022; 17: e0266755.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time