Background: In psychiatric emergencies, there is a high premium on rapid assessment and acuity categorization. The Crisis Triage Rating Scale (CTRS), a 3-item clinician-rated instrument, has been validated for assessing the severity or urgency of emotional crises in psychiatric emergency units across several continents. The CTRS also expedites the screening of patients who require hospital admission from those who are suitable for out-patient treatment. However, its utility has not been evaluated in Nigeria.
Aim: This study aimed to assess the psychometric properties of the CTRS in patients presenting to a psychiatric emergency unit in Nigeria.
Method: The CTRS was administered to consecutively presenting patients (N=247) at the Emergency Unit of the Federal Neuro-Psychiatric Hospital, Yaba, Lagos, Nigeria. Following a comprehensive psychiatric evaluation, clinicians blinded to the CTRS scores rated the urgency of each case and made appropriate decisions regarding the disposal of the patients. The ability of the CTRS to discriminate between various levels of urgency of crises and to predict the need for admission at different threshold scores, compared with clinical judgement as criterion, was determined statistically.
Results: CTRS scores ranged from 3 to 15 with a median score of 13 (IQR 11 to 15). The optimal threshold on the CTRS for detecting ‘the most urgent category of crises’ is a cut-off score of 10 as it has the best trade-off with a sensitivity of 0.93 and specificity of 0.87. At this threshold, the overall misclassification rate is 0.09, while the area under the Receiver operating characteristics curve is 0.95. The positive predictive validity for the assessment of disposal at the optimum threshold is 0.91.
Conclusion: The CTRS is a useful tool in the triaging and disposal of patients presenting to psychiatric emergency service in Nigeria.