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Validation of the Cipto Triage Method: A Single-Centre Study from Indonesia

Authors Habib H, Sulistio S, Albar IA, Mulyana RM, Yundiarto N

Received 19 January 2020

Accepted for publication 30 April 2020

Published 18 May 2020 Volume 2020:12 Pages 137—143


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Bo Løfgren

Hadiki Habib, Septo Sulistio, Imamul Aziz Albar, Radi Muharris Mulyana, Nova Yundiarto

Emergency Unit, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Correspondence: Hadiki Habib
Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
10430 Tel +62 81263488115
Fax +62 213905840

Purpose: A national referral hospital in Indonesia developed a three-category triage acuity method called the Cipto Triage Method (CTM) for emergency departments (ED) in developing countries. This was a validation study to assess the performance of the triage method.
Methods: This cohort, retrospective, single-centre study was conducted in the ED of Cipto Mangunkusumo Hospital that receives approximately 30,000 patient visits per year. The ED medical records throughout the year 2017 were randomly selected as the study sample. Completely written forms of triage and ED initial assessment were included in this study. Validation of the CTM decision was done by using expert panel opinion as reference standard, and also using surrogate conditions such as patient outcome for hospital admission and in-hospital mortality.
Results: There were 1348 samples assigned to the following three categories: resuscitation (14.9%), urgent (63.8%) and non-urgent (21.3%). Overall accuracy was more than 80%, positive predictive value and negative predictive value for resuscitation category were 99% (95% confidence interval [CI], 96.5– 99.9) and 96.9% (95% CI, 95.7− 97.8), respectively. Resuscitation category had a relative risk (RR) for admission of 1.341 (95% CI, 1.259– 1.429) and a RR for mortality of 4.294 (95% CI, 3.180– 5.799). Undertriage increases the risk of mortality compared to correct triage (RR, 3.1; 95% CI, 2.11– 4.54).
Conclusion: CTM has a good criterion and construct validity; it is also easy to understand and can accommodate a simple ED design in the majority of hospitals in Indonesia.

Keywords: triage, emergency department, validation

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