Over-Triage in Casevac Categorisation is Common in Hong Kong

Abstract

Objective To review the categorisation of patients who were transferred out from out-lying islands to urban hospitals utilising casualty evacuation (CASEVAC), and to search for possible patient characteristics which might have contributed to mis-categorisation during the ‘non-flying’ hours. Methods The medical records of 459 patients, who were transferred out in the year 2009 were reviewed. Correctness of categorisation was determined by 2 independent assessors according to the CASEVAC guidelines. The rates of mis-categorisation between ‘clinic hours’ and ‘AED hours’, and that between the ‘flying’ and ‘non-flying’ hours, were compared. The patients' demographic data and their presenting symptoms were collected and analysed using logistic regression models to identify factors contributing to mis-categorisation. Results The mis-categorisation rate was 60.1%. Among them, all were over-categorised. The over-categorisation rates between ‘clinic hours’ and ‘AED hours’, and between ‘flying’ and ‘non-flying’ hours, were not significantly different (p=0.07 and 0.09, respectively). Abnormal pulse rate was significantly associated with over-categorisation (p<0.01). Patients at extremes of age and psychiatric/drunk patients were significantly less likely to be over-categorised (p<0.05 and p<0.01, respectively). There was 20% disagreement between the two assessors when applying the existing CASEVACs guidelines (kappa score 0.58 or ‘moderate agreement’). Conclusions Over-triage in CASEVAC categorisation is common irrespective of the time of day. Revision of the current CASEVAC guidelines is recommended. (Hong Kong j.emerg.med. 2013; 20:327-336)