In this study more than half of AMI patients were triaged under low priority triage category. 47.3% (38.9%-56.5%) of the patients categorized under High priority triage category. Among the factors triage nurse experience and TEWS has a positive significant association on categorizing AMI patients under High priority triage category.
In this study by using cape triage system 47.3% of AMI patients were categorized under high priority triage category. In other studies which were done on other triage systems such as MTS also showed that the percentage of high priority categorized AMI patients were within the range of this study finding(18, 11).
In other studies which were done on ATS and CTS were showed that the percentage of high priority triaged patients were higher as 80% (19, 12). This difference might cause by sample size which this study used was at least 10 times less than other studies were used, which might increase the prevalence.
Although age hasn’t a significant effect in categorizing AMI patients, the mean age of the study participants were 54.4 years with SD 12.73 in this study. This finding was similar to other studies done in other studies (21). In other study done in Brazil Hospital showed that age hadn’t a significant effect in categorizing AMI patients (5).other study showed that younger age AMI patients were highly categorizing under high priority triage category. In contrary in other studies the finding implicates older age had a positive significant effect on categorizing under high priority triage category (12, 9).these differences might be explained by the number of sample size. Most of the other studies were used higher sample size which will increase a chance of getting a significant effect on the outcome variable and also as a mean age of the patients implicates most of the patients were older age groups which might cause a positive significance on the outcome variable. But in other study negative significance between age and the outcome variable needs a further investigation to know the cause.
Although mode of arrival had not a significant effect on priority categorization, most of ambulance arrival patients were categorized under high priority triage category. This finding also supported by other similar findings (21). But ambulance arrival had a positive effect on categorizing patients under high priority category in other different studies which were studied on other triage systems (11, 12).
75.57% of chief complaint of the patients in this study was chest pain; however chest pain hadn’t a significant association on prioritization of AMI patients. In other study done at Brazil Hospitals found similar finding on the association of chest pain and care priority (5). But other study found that having chest pain during admission had a positive significance on categorizing AMI patients under high priority triage category.
Hypertension was the common risk factor which was found on 41.2% AMI patients on this study. The prevalence of HTN was also similar as this finding in other study done in MTS (22). There is also a study which was done at Brazil hospitals found 68.6% of patients had HTN as a risk factor and also high systolic and diastolic blood pressure had a positive significance on categorizing AMI patients under high priority triage category (5). But in this study HTN had not any significant effect on categorizing AMI patients.
Among chest pain characteristics onset of pain of more than 24 hours and severe pain accounts higher number in the study participants; however either onset or severity hadn’t a significant effect in categorizing AMI patients. But in a study done in MTS at Brazil hospitals showed that onset of pain of less than 1 hours had a positive significant effect (P < 0.001) on categorizing AMI patients under high priority triage category and also higher pain intensity had a positive effect (P < 0.001) on categorizing AMI patients in high priority triage category (5).
Triage nurse experience had a positive significant effect in AMI patients’ prioritization. In this study nurses who had more than 5 years of triage experience had 11 times more likely categorizing AMI patients under high priority triage category as compared to nurses who had less than 2 years triage experience. But other studies showed that nurse experience hadn’t any significant effect on categorizing AMI patients (21). These differences might be explained by difference on educational curriculum on the nursing school. The other studies were undertake on Latin America and Europe countries, in this countries nursing school might incorporate the detail sign symptoms of AMI patients in the undergraduate and graduate studies. This might explain there was not a significant difference between junior and senior nurses on categorizing AMI patients.
In this study TEWS was one of the factors which affect AMI patients categorization (P < 0.001). It showed AMI patients who had 5–10 TEWS had 65 times likely categorizing under high priority triage category as compared to patients who had 1–4 TEWS. But most of the study participants had a TEWS of 1–4. AMI patients who had 1–4 TEWS were 98% less likely categorized under high priority triage category. Therefore more than half of AMI patients were categorized under low priority triage category. This finding implicates that most of triage nurses were using TEWS rather than using chief complaint of the AMI patients who come at emergency triage room. This leads increased number of low TEWS score patients categorized under low priority triage category.
As a limitation of this study, it was done by using retrospective chart review method. This might not incorporate much information about the patients’ clinical information and any other additional information. And also this study only explained the association of high priority triage category and the associated factors. It does not include low priority triage category association with the independent variables. Additionally this study used a small sample size which might have effect on the relations between the dependent and independent variables. And also this study had done at only one tertiary hospital.
As strength this study were done at a tertiary hospital which has a high flow of patients in the emergency department. This might enable as to generalize the study findings. This study tried to explain the unseen side of treatment in AMI patients, which can be a milestone finding to improve the early treatment of AMI patients at emergency departments in the tertiary hospitals.