PloS one
Comparison of three emergency department triage systems among Thai medical students: A randomized three-period crossover simulation study
By Yaowalaorng J, Lokeskrawee T, Pruksathorn N and 6 others.
Abstract
Introduction
In Thailand, the Emergency Severity Index (ESI) and Ministry of Public Health Emergency Department triage system (MOPH) are commonly used, whereas the Thai Rapid Initial Assessment and Grading for Emergency (TRIAGE) system has been newly proposed. Comparative evidence is limited. We compared correct triage as the primary outcome, with under-triage, over-triage, and completion time as secondary outcomes.
Methods
We conducted a randomized three-period crossover simulation study at the Lampang Medical Education Center from October 2025 to January 2026. Fifth- and sixth-year medical students without recent standardized triage reinforcement classified 50 standardized patient cards per system in one of six sequences, with a one-week washout between periods. Multilevel mixed-effects models were used to estimate between-system differences, with adjustment for period, sequence, and academic year.