title: The Copenhagen Triage Algorithm: a randomized controlled trial.
abstract: BACKGROUND
  Crowding in the emergency department (ED) is a well-known problem resulting in an increased risk of adverse outcomes. Effective triage might counteract this problem by identifying the sickest patients and ensuring early treatment. In the last two decades, systematic triage has become the standard in ED's worldwide. However, triage models are also time consuming, supported by limited evidence and could potentially be of more harm than benefit. The aim of this study is to develop a quicker triage model using data from a large cohort of unselected ED patients and evaluate if this new model is non-inferior to an existing triage model in a prospective randomized trial.
  
  
  METHODS
  The Copenhagen Triage Algorithm (CTA) study is a prospective two-center, cluster-randomized, cross-over, non-inferiority trial comparing CTA to the Danish Emergency Process Triage (DEPT). We include patients ≥16 years (n = 50.000) admitted to the ED in two large acute hospitals. Centers are randomly assigned to perform either CTA or DEPT triage first and then use the other triage model in the last time period. The CTA stratifies patients into 5 acuity levels in two steps. First, a scoring chart based on vital values is used to classify patients in an immediate category. Second, a clinical assessment by the ED nurse can alter the result suggested by the score up to two categories up or one down. The primary end-point is 30-day mortality and secondary end-points are length of stay, time to treatment, admission to intensive care unit, and readmission within 30 days.
  
  
  CONCLUSIONS
  If proven non-inferior to standard DEPT triage, CTA will be a faster and simpler triage model that is still able to detect the critically ill. Simplifying triage will lessen the burden for the ED staff and possibly allow faster treatment.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT02698319 , registered 24. of February 2016, retrospectively registered.
authors.affiliation: Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark. r.hasselbalch@gmail.com.
authors.forename: Rasmus Bo
authors.initials: RB
authors.lastname: Hasselbalch
authors.affiliation: Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Louis Lind
authors.initials: LL
authors.lastname: Plesner
authors.affiliation: Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Mia
authors.initials: M
authors.lastname: Pries-Heje
authors.affiliation: Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Lisbet
authors.initials: L
authors.lastname: Ravn
authors.affiliation: Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Lind
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Greibe
authors.affiliation: Department of Emergency Medicine, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Birgitte Nybo
authors.initials: BN
authors.lastname: Jensen
authors.affiliation: Department of Anaesthesia, Center of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Rasmussen
authors.affiliation: Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark.|Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Iversen
mesh_terms: D000465:Algorithms; D016638:Critical Illness; D018592:Cross-Over Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy
keywords: Emergency Department; Triage; Vital signs