Valor preditivo do protocolo de classificação de risco em Unidade de Urgência de um Hospital Municipal de Belo Horizonte

Abstract

Cohort, prospective and analytical study to establish the predictive value of ManchesterTriage System deployed in a municipal hospital in Belo Horizonte, Minas Gerais. The studypopulation consisted of all users admitted to the emergency department and who wereassessed and classified by Manchester Triage System (MTS©). The sample calculation forstratified by color category was 300 patients. Were included in study, the patients classifiedby MTS© who remained in hospital for at least 24 hours. Were excluded those patientsclassified in green and blue who are sent to primary care services or outpatient. The primaryoutcome assessed was the score obtained by patients through the Therapeutic InterventionScoring System - 28 (TISS-28). Secondary outcomes evaluated included mortality, discharge /transfer and hospitalization time. To characterize the sample in relation to sex was performeddescriptive analysis with absolute frequencies. Regarding age, we carried out the calculationof measures of central tendency and dispersion. Descriptive analysis of the flow charts usedfor classification of patients was performed using simple percentages and absolutefrequencies. Analysis of the TISS-28 was obtained by averaging the scores received in eachclassification group. For the analysis of dependent variables - death and discharge / transfer -we used the chi-square (X2) Pearson. The measures of association between variables werecalculated by odds ratio (OR) confidence interval of 95%. The confounding variables controlwas performed using logistic regression. The analysis of length of stay was performed aftercalculation of the average stay in each group and standard deviation, confidence interval 95%.Among the 300 patients, 172 were male (57.0%) and 128 (43.0%) were female. The averageage of the red group was 58.6 years; orange group 57.5 years; and yellow group 55.7 years.The flowcharts dyspnea, illness in adults, chest pain, strange behavior and loss ofconsciousness were the most used. The average TISS score - 28 in the yellow group was 8.9points; the orange group, 12.5 points and the red group, 23.3 points, with statisticallysignificant difference among the three groups. It was found that patient's chance of dyingwhen ranked in the red group is 3.6 times higher compared to patients included in orangegroup and 7.1 times higher compared to patients in the yellow group. The yellow group hadan average hospital stay of 9.6 days, orange 14.6 days and red 14.7 days. The red grouppatients evolved more severely and has a higher mortality compared with the patients oforange and yellow groups. These data confirm that the clinical course of patients is differentbetween the groups. This study contributes uniquely to the prediction analysis of ManchesterTriage System which has been implemented in health services nationally and internationally.