Over‐Triage in Casevac Categorisation is Common in Hong Kong

ObjectiveTo review the categorisation of patients who were transferred out from out‐lying islands to urban hospitals utilising casualty evacuation (CASEVAC), and to search for possible patient characteristics which might have contributed to mis‐categorisation during the ‘non‐flying’ hours.MethodsThe medical records of 459 patients, who were transferred out in the year 2009 were reviewed. Correctness of categorisation was determined by 2 independent assessors according to the CASEVAC guidelines. The rates of mis‐categorisation between ‘clinic hours’ and ‘AED hours’, and that between the ‘flying’ and ‘non‐flying’ hours, were compared. The patients' demographic data and their presenting symptoms were collected and analysed using logistic regression models to identify factors contributing to mis‐categorisation.ResultsThe mis‐categorisation rate was 60.1%. Among them, all were over‐categorised. The over‐categorisation rates between ‘clinic hours’ and ‘AED hours’, and between ‘flying’ and ‘non‐flying’ hours, were not significantly different (p=0.07 and 0.09, respectively). Abnormal pulse rate was significantly associated with over‐categorisation (p<0.01). Patients at extremes of age and psychiatric/drunk patients were significantly less likely to be over‐categorised (p<0.05 and p<0.01, respectively). There was 20% disagreement between the two assessors when applying the existing CASEVACs guidelines (kappa score 0.58 or ‘moderate agreement’).ConclusionsOver‐triage in CASEVAC categorisation is common irrespective of the time of day. Revision of the current CASEVAC guidelines is recommended. (Hong Kong j.emerg.med. 2013; 20:327‐336)