Unclear Group Formation
The article concludes that more than half of patients do not fall within the definition of a medical emergency due to their low subjective urgency for treatment (1).
I cannot share this conclusion from the data presented, based on two reasons:
Calculation process. Of 1175 patients, 54.7% have a self-reported treatment urgency from 0 (no urgent need for treatment) to 5 from a scale up to 10 (very urgent, acute mortal danger)—that is, 643 patients. There was a collective of 6488 patients during the observation period. 643/6488 patients is 9.9%. Thus, taking into account all patients during the observation period, I conclude that less than 10% of patients stated that their treatment urgency was from 0 to 5.
Group formation. It should be noted that the rating scale ranged from 0 to 10, yet it was classified as low up to 5, and as high starting from 6: „Patients themselves estimated how urgently they needed treatment by using a numerical rating scale from 0 to 10; subsequently the subjectively perceived treatment urgency was categorized into two groups: low—i.e., 0–5; and high—i.e., 6–10. „ The „low“ category ranges from 0 to 5—that is, it contains six possible choices for the patients, while the „high“ category only has five possible choices. An „urgent“ rating that would consequently be between „not urgent“ and „very urgent“—that is, at 4, 5, or 6 points—was not offered. Did the patients know which group their score was in, or did they perhaps assume that a score of 5, the middle of the scale, was „urgent“? If they did not know, I do not think that it is feasible to retrospectively form the two groups. What exactly did the rating scale look like? After all, the majority of patients chose the value 5. A comparison with the triaging by clinical staff does not fit, because the grouping was „urgent“, „normal“, „not urgent“, and „not specified“. Thus, there are doubts as to whether the 18% (1175/6488) of the patients who submitted a rating were even sure about into which rating group their estimations would fall.
Dr. med. Mechthild Waldeyer-Sauerland
|1.||Scherer M, Lühmann D, Kazek A, Hansen H, Schäfer I: Patients attending emergency departments—a cross-sectional study of subjectively perceived treatment urgency and motivation for attending. Dtsch Arztebl Int 2017; 114: 645–52 VOLLTEXT|