Criterion validity of a computer-assisted instrument of self-triage (ca-ISET) compared to the validity of regular triage in an ophthalmic XXXX .

@entity1 @entity341 @entity2286
OBJECTIVES: The computer-assisted version of a self-triage tool (ca-ISET) for an ophthalmic @entity341 ( @entity341 ) was developed to increase the validity of the triage procedure when trained @entity341 staff is absent. METHODS: We tested whether sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value ( @entity2286 ) of the ca-ISET deviated from regular triage. @entity1 >= 18 years visiting the @entity341 of the Rotterdam Eye Hospital in the Netherlands were invited to participate in this prospective study. This @entity341 focuses on eye-related problems. @entity1 recruitment was carried out during working hours. The ca-ISET is a touch operated software application and the algorithm of the triage is based in the Manchester triage system. For all @entity1 three triage scores were determined by (1) the @entity1 using the ca-ISET; (2) triage by a regular, trained triage assistant and (3) triage by one physician who was specially trained in ophthalmic triage. The diagnosis of the physician was chosen as the reference standard to define criterion validity. The order of triage administration was alternated per @entity1 . Only cases with triage scores from the two triage systems and the reference standard were included. The outcome variables, four triage colours, were transformed into a binary score: high urgent and low urgent. The difference between the ca-ISET and regular triage in terms of sensitivity, specificity, NPV and @entity2286 was tested by Z-scores. RESULTS: Of 247 eligible @entity1 , data was elicited from 189 @entity1 (average age 54 years, range 18-89). The sensitivity of the ca-ISET (0.89, CI: 0.75-0.96) did not differ from the sensitivity of the regular triage (0.69, CI: 0.53-0.82, Z=1.74, p=0.08). The ca-ISET was less specific (0.78, CI: 0.71-0.84) than the regular triage (0.92, CI=0.86-0.95, Z=3.04, p=0.00). We found no significant difference between the ca-ISET and regular triage for @entity2286 (Z=0.19, p=0.85) and NPV (Z=0.03, p=0.98). CONCLUSIONS: The sensitivity, @entity2286 and NPV of the ca-ISET does not differ from the sensitivity of the regular triage, while the ca-ISET retained a reasonable level of specificity. Therefore the ca-ISET can be recommended as a tool for ophthalmic emergency departments, and could be used when trained @entity341 staff is absent.
