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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

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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
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

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