Hostname: page-component-77f85d65b8-45ctf Total loading time: 0 Render date: 2026-03-30T00:47:56.863Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment of inter-observer reliability of two five-level triage and acuity scales: a randomized controlled trial

Published online by Cambridge University Press:  21 May 2015

Andrew Worster ,
Nicki Gilboy ,
Christopher M. Fernandes ,
David Eitel ,
Kevin Eva ,
Rose Geisler  and
Paula Tanabe
Andrew Worster*
Affiliation:
Department of Emergency Medicine, Hamilton Health Sciences, Hamilton, Ont. Department of Clinical Epidemiology, McMaster University, Hamilton, Ont.
Nicki Gilboy
Affiliation:
Brigham and Womens Hospital, Boston, Mass.
Christopher M. Fernandes
Affiliation:
Department of Emergency Medicine, Hamilton Health Sciences, Hamilton, Ont.
David Eitel
Affiliation:
Department of Emergency Medicine, York Hospital, York, Pa.
Kevin Eva
Affiliation:
Department of Clinical Epidemiology, McMaster University, Hamilton, Ont.
Rose Geisler
Affiliation:
Department of Emergency Medicine, Hamilton Health Sciences, Hamilton, Ont.
Paula Tanabe
Affiliation:
Feinberg School of Medicine, Northwestern University, Chicago, Ill.
*
Department of Emergency Medicine, Hamilton Health Sciences, 237 Barton St. E, Hamilton ON L8N 3Z5; 905 527-4322 x46997, fax 905 527-7051, aworster@rogers.com

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the 'Save PDF' action button.
Introduction:

The Emergency Severity Index (ESI©) is an initial measure of patient assessment in the emergency department (ED). It rates patients based on acuity and predicted resource intensity from Level 1 (most ill) to Level 5 (least resource intensive). Already implemented and evaluated in several US hospitals, ESI has yet to be evaluated in a Canadian setting or compared with the fivelevel Canadian Emergency Department Triage and Acuity Scale (CTAS).

Objective:

To compare the inter-observer reliability of 2 five-level triage and acuity scales.

Methods:

Ten triage nurses, who had all been trained in the use of CTAS, from 4 urban, academic Canadian EDs were randomly assigned either to training in ESI version 3 (ESI v.3) or to refresher training in CTAS. They independently assigned triage scores to 200 emergency cases, unaware of the rating by the other nurses.

Results:

Number of years of nursing practice was the only significant demographic difference found between the 2 groups (p = 0.014). A quadratically weighted kappa to measure the inter-observer reliability of the CTAS group was 0.91 (0.90, 0.99) and not significantly different from that of the ESI group 0.89 (0.88, 0.99). An inter-test generalizability (G) study performed on the variance components derived from an analysis of variance (ANOVA) revealed G(5) = 0.90 (0.82, 0.99). Conclusions: After 3 hours of training, experienced triage nurses were able to perform triage assessments using ESI v.3 with the same inter-observer reliability as those with experience and refresher training in using the CTAS.

Keywords

triageacuityemergency departmentrandomized controlled trial

Information

Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 4 , July 2004 , pp. 240 - 245
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.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;34(2):155–9.CrossRefGoogle ScholarPubMed
2.Wuerz, R, Fernandes, CM, Alarcon, J.Inconsistency of emergency department triage. Emergency Department Operations Research Working Group. Ann Emerg Med 1998;32(4):431–5.Google Scholar
3.Beveridge, R, Clarke, B, Janes, L, Savage, N, Thompson, J, Dodd, G, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. CJEM 1999;1(3 Suppl). Online version available at: www.caep.ca/002.policies/00202.ctas.htm (accessed 19 May 2004).Google Scholar
4.MacKway-Jones, K, editor. Manchester Triage Group. Emergency Triage. London: BMJ Publishing Group; 1997.Google Scholar
5.The Australasian Triage Scale [policy document]. Australasian College for Emergency Medicine. Emerg Med 1994;6:145–6.Google Scholar
6.Wuerz, RC, Milne, LW, Eitel, DR, Travers, D, Gilboy, N.Reliability and validity of a new five-level triage instrument. Acad Emerg Med 2000;7(3):236–42.CrossRefGoogle ScholarPubMed
7.Eitel, DR, Travers, DA, Rosenau, AM, Gilboy, N, Wuerz, RC.The emergency severity index triage algorithm version 2 is reliable and valid. Acad Emerg Med 2003;10(10):1070–80.Google Scholar
8.Tanabe, P, Gimbel, R, Yarnold, PR, Kyriacou, DN, Adams, JG.Reliability and validity of scores on The Emergency Severity Index version 3. Acad Emerg Med 2004;11(1):59–65.CrossRefGoogle ScholarPubMed
9.Jelinek, GA, Little, M.Inter-rater reliability of the National Triage Scale of 11,500 simulated occasions of triage. Emerg Med 1996;8:226–30.Google Scholar
10.Hollis, G, Sprivulis, P.Reliability of the National Triage Scale with changes in emergency department acuity level. Emerg Med 1996;8:231–4.CrossRefGoogle Scholar
11.Manos, D, Petrie, DA, Beveridge, RC, Walter, S, Ducharme, J.Interobserver agreement using the Canadian Emergency Department Triage and Acuity Scale. Can J Emerg Med 2002;4(1);16–22.CrossRefGoogle ScholarPubMed
12.Streiner, DL, Norman, GR.>Health measurement scales: a pracical guide to their development and use. 3rd ed. New York: Oxford University Press; 2003. p. 148–51.Health+measurement+scales:+a+pracical+guide+to+their+development+and+use.+3rd+ed.+New+York:+Oxford+University+Press;+2003.+p.+148–51.>Google Scholar
13.Brillman, JC, Doezema, D, Tandberg, D, Sklar, DP, Davis, KD, Simms, S, et al. Triage: limitations in predicting need for emergent care and hospital admission. Ann Emerg Med 1996;27(4):493–500.Google Scholar
14.Streiner, DL, Norman, GR.Health measurement scales: a practical guide to their development and use, 2nd ed. Oxford: Oxford University Press; 1995. p. 144–6.Google Scholar
15.Sun, BC, Adams, JG, Burstin, HR.Validating a model of patient satisfaction with emergency care. Ann Emerg Med 2001;38: 527–32.Google Scholar
16.Fernandes, CM, Wuerz, R, Clark, S, Djurdjev, O.How reliable is emergency department triage? Ann Emerg Med 1999;34(5):141–7.CrossRefGoogle ScholarPubMed