Work of Breathing Assessment in Triage Scale

The proposed research study will be a prospective observational study designed to validate the Canadian Triage Assessment Scale (CTAS) in regard to work of breathing in patients in the emergency department. The investigators will assess inter-rater agreement between nurses & emergency physicians for assessment of work of breathing.

Study Overview

• Status: Active, not recruiting
• Conditions: Cough; Hypoxemia; Shortness of Breath; Respiratory Symptoms; Difficulty Breathing
• Intervention / Treatment: Other: Canadian Triage Assessment Scale (CTAS)

Detailed Description

Investigators will enroll a convenience sample of consenting patients who present to the emergency department with a chief complaint related to respiratory symptoms, including shortness of breath, cough, difficulty breathing, hypoxemia, or any other respiratory related complaint.

Following consent and in a blinded fashion, the nurse & emergency physician will be asked to evaluate the patient's work of breathing into three subjective categories: mild, moderate, or severe. The two evaluators will not be aware of the others evaluation of the patient. Evaluators will also be asked to predict the patients likely need for intervention & disposition.

Subsequently, investigators will perform a chart review to determine the patient's clinical interventions, outcomes, and dispositions, and evaluate the assessment of the patients work of breathing.

• Study Type: Observational
• Enrollment (Actual): 39

Contacts and Locations

Study Locations

• United States
  • Texas
    • Corpus Christi, Texas, United States, 78405
      • CHRISTUS Spohn Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Study subjects include any adult patients who present to the emergency department at Christus Spohn Hospital - Shoreline

Description

Inclusion Criteria:

• 18 years of age of older
• Presenting to the emergency department with a chief complaint of any type of respiratory symptom.

Exclusion Criteria:

• Under 18 years of age
• Refusal to consent to study
• Incarcerated patients
• Pregnant patients
• Unable to complete survey due to clinical instability, severe pain, or disorientation determined by a study physician.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patients with Respiratory Symptoms; The Canadian Triage Assessment Scale (CTAS) will be assessed via patient survey form and electronic chart review.	Other: Canadian Triage Assessment Scale (CTAS); The CTAS incorporates work of breathing into a subjective measurement in its assessment of patients and triaged.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inter-rater agreement between nurses and emergency physicians for the respiratory component of the Canadian Assessment Scale (CTAS)	The CTAS is utilized to qualitatively define work of breathing as severe, moderate, or mild. Kappa will be calculated to assess inter-rater reliability	24 months

Collaborators and Investigators

• Sponsor: CHRISTUS Health
• Investigators: Principal Investigator: Christopher Durand, DO, CHRISTUS Health

Publications and helpful links

General Publications

• Rui P, Kang K, Albert M. National Hospital Ambulatory Medical Care Survey: 2013 Emergency Department Summary Tables. Available from: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2013_ed_web_tables.pdf.
• Hutchinson A, Pickering A, Williams P, Bland JM, Johnson MJ. Breathlessness and presentation to the emergency department: a survey and clinical record review. BMC Pulm Med. 2017 Mar 20;17(1):53. doi: 10.1186/s12890-017-0396-4.
• Murray M, Bullard M, Grafstein E; CTAS Natioanal Working Group; CEDIS National Working Group. Revisions to the Canadian Emergency Department Triage and Acuity Scale implementation guidelines. CJEM. 2004 Nov;6(6):421-7. No abstract available.
• Horeczko T, Enriquez B, McGrath NE, Gausche-Hill M, Lewis RJ. The Pediatric Assessment Triangle: accuracy of its application by nurses in the triage of children. J Emerg Nurs. 2013 Mar;39(2):182-9. doi: 10.1016/j.jen.2011.12.020. Epub 2012 Jul 24.
• Jimenez JG, Murray MJ, Beveridge R, Pons JP, Cortes EA, Garrigos JB, Ferre MB. Implementation of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the Principality of Andorra: Can triage parameters serve as emergency department quality indicators? CJEM. 2003 Sep;5(5):315-22.
• Alquraini M, Awad E, Hijazi R. Reliability of Canadian Emergency Department Triage and Acuity Scale (CTAS) in Saudi Arabia. Int J Emerg Med. 2015 Dec;8(1):80. doi: 10.1186/s12245-015-0080-5. Epub 2015 Aug 7.
• Paniagua N, Elosegi A, Duo I, Fernandez A, Mojica E, Martinez-Indart L, Mintegi S, Benito J. Initial Asthma Severity Assessment Tools as Predictors of Hospitalization. J Emerg Med. 2017 Jul;53(1):10-17. doi: 10.1016/j.jemermed.2017.03.021. Epub 2017 Apr 14.
• Roussos C, Koutsoukou A. Respiratory failure. Eur Respir J Suppl. 2003 Nov;47:3s-14s. doi: 10.1183/09031936.03.00038503.
• Beveridge R, Ducharme J, Janes L, Beaulieu S, Walter S. Reliability of the Canadian emergency department triage and acuity scale: interrater agreement. Ann Emerg Med. 1999 Aug;34(2):155-9. doi: 10.1016/s0196-0644(99)70223-4.

Study record dates

Study Major Dates

• Study Start (Actual): October 30, 2020
• Primary Completion (Estimated): June 1, 2025
• Study Completion (Estimated): October 1, 2025

Study Registration Dates

• First Submitted: July 21, 2022
• First Submitted That Met QC Criteria: July 27, 2022
• First Posted (Actual): July 29, 2022

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 4, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Emergency Room; Work of Breathing; Respiratory Assessment
• Additional Relevant MeSH Terms: Pathologic Processes; Respiratory Tract Diseases; Respiration Disorders; Respiratory Aspiration; Hypoxia; Dyspnea; Signs and Symptoms, Respiratory
• Other Study ID Numbers: 2020-195

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The Principal Investigator may want to pursue other opportunities with collaborators and sponsors.
• IPD Sharing Time Frame: 24 months
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No