Comparison of Reliability and Validity of the Chinese Four-Level and Three-District Triage Standard and the Australasian Triage Scale

Abstract

Emergency triage is an important tool for prioritizing urgent or critical patients, and its effect needs to be investigated and evaluated. This observational study aimed to compare the reliability and validity of the Chinese four-level and three-district triage standard (CHT) and the Australasian Triage Scale (ATS) in an adult emergency department of a general hospital in China. From 2016-01 to 2017-01, twelve nurses independently performed on-site triage of 254 patients and 1552 patients to assess the scales' reliability and validity, respectively. The interrater reliability, as assessed by the weighted k scores, was 0.686 (95% CI 0.608–0.757) for the CHT and 0.731 (95% CI 0.663–0.790) for the ATS, and the k scores between the CHT and the ATS were 0.630 (95% CI 0.594–0.669). Temperature, respiration, pulse, blood oxygen saturation, waiting time, treatment time, emergency disposition, hospitalization rate, and mortality were significantly associated with the triage levels of the CHT and ATS (p < 0.001). The area under the receiver operating characteristic (AUROC) curve values of the CHT and ATS for predicting intensive care treatment were 0.845 (95% CI: 0.825–0.866) and 0.740 (95% CI: 0.715–0.765), respectively. The reliability and validity of the CHT and ATS were moderate, and both of them can be used to identify critical patients in emergency departments. It is necessary to further improve the triage system in terms of structure and content.

The influence of coronavirus disease 2019 on emergency department visits in Nanjing, China: A multicentre cross-sectional study

“…Data on ED visits were obtained from 28 hospitals with ED electronic record systems (ERS). We collected the following data: total numbers of ED visits; critically ill patients (defined as triage grade I and II according to Chinese Emergency Triage Scale (ETS) [ 6 ]. The ETS has five grades (I, II, III, IVa and IVb) and is equivalent to the American Emergency Severity Index (ESI) [ 7 ] levels of 1–5.…”

Development of a Web-Based Korean Triage and Acuity Scale Learning Program for Emergency Department Nurses

“…In the development of this learning program, literature related to the Emergency Severity Index from the United States, the Australasian Triage Scale from Australia, and the CTAS from Canada, ED triage systems upon which the KTAS was based, were searched and analyzed. [18][19][20][21][22][23][24] In the interviews of ED nurses who completed the KTAS provider training and participated in the focus group, the nurses stated that they believed their performance of KTAS procedures was unsatisfactory despite being certified as KTAS providers. They also mentioned the need for regular training with real cases involving the KTAS.…”

Triage practice in emergency departments in tertiary hospitals across China: A multicenter national descriptive survey

“…In the triage process, triage nurses play an important role, and can contribute significantly to patients' positive health outcomes (Rehman & Ali, 2016; Zhu et al, 2019). Recommended qualifications of triage nurses specify that registered nurses should have sufficient nursing experience and specialist knowledge, and should receive comprehensive triage training (Peng & Hammad, 2015).…”

“…Experts are involved in the improvement of the triage process in mainland China (Guo et al, 2020; Jin et al, 2016; Shi et al, 2018; Zhu et al, 2019). Targeting triage status, Hammad et al (2017) examined city‐level triage practices and knowledge of emergency nurses in Hunan Province, China.…”

“…The three ED districts are the red zone, which includes the resuscitation room, the rescue room, the emergency operation room, and the emergency intensive care unit for patients with immediate and very urgent symptoms; the yellow zone, which includes the waiting room and the observing room for patients with urgent symptoms; and the green zone, which is an area for the rapid treatment of patients with nonurgent symptoms. Experts are involved in the improvement of the triage process in mainland China (Guo et al, 2020;Jin et al, 2016;Shi et al, 2018;Zhu et al, 2019). Targeting triage status, Hammad et al (2017)…”