The Copenhagen Triage Algorithm can be used to triage patients in the Emergency Department.
Parameters:
(1) supplemental oxygen therapy
(2) systolic blood pressure in mm Hg
(3) respiratory rate in breaths per minute
(4) heart rate in beats per minute
(5) percutaneous oxygen saturation in percent (SpO2)
Parameter
Finding
Points
supplemental oxygen
no
0
yes
4
systolic blood pressure
>= 100 mm Hg
< 100 mm Hg
3
respiratory rate
<= 22 breaths per minute
> 22 breaths per minute
heart rate
<= 110 beats per minute
> 110 beats per minute
2
SpO2
>= 94%
< 94%
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
• The triage nurse can adjust the status up or down 1 or 2 levels based on the clinical assessment.
Score
Status
Color Code
Re-Evaluate
non-urgent
green
constant
2 or 3
urgent
yellow
every 15 minutes
4 to 7
emergent
orange
every 60 minutes
8 to 14
life threatening
red
every 3 hours
Performance:
• The area under the ROC curve is 0.74
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Specialty: Surgery, orthopedic, Emergency Medicine
