Limitations in validating emergency department triage scales

Twomey, Michèle; Wallis, Lee; Myers, Jonathan E.

doi:10.1136/emj.2007.046383

Cited by 110 publications

(134 citation statements)

References 15 publications

(16 reference statements)

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“…This can be viewed as a kind of construct validity and eliminates the many confounders to the surrogate measures already mentioned. 11 The HKAETG demonstrated substantial agreement between the expert panel and triage nurses. This suggests that in general, the HKAETG is a valid instrument for measuring patient acuity in the local setting.…”

Section: Discussionmentioning

confidence: 87%

Validation of the Hong Kong Accident and Emergency Triage Guidelines

Fan¹,

Leung²

2013

Hong Kong Med J

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Main outcome measuresThe inter-rater reliability in two pairs of nurses grouped according to experience and validity as compared with an expert panel.Results Of the 100 patients recruited and triaged into levels 1 to 5, the weighted kappa coefficient (inter-rater reliability) for the two pairs of nurses was 0.699 and 0.717, respectively. The weighted kappa coefficient for validity was 0.766. When only patients in triage levels 3 and 4 were included, the weighted kappa coefficient for reliability dropped to 0.632 and 0.585, respectively. The weighted kappa coefficient for validity also decreased to 0.558. ConclusionsThe overall inter-rater reliability and validity of the Guidelines appeared acceptable. Further revision of the Guidelines on triaging patients to levels 3 or 4 is probably necessary.

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Section: Discussionmentioning

confidence: 87%

Validation of the Hong Kong Accident and Emergency Triage Guidelines

Fan¹,

Leung²

2013

Hong Kong Med J

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“…There are no set standards for validation of triage tools, [16][17][18] but it is sensible Red, orange or yellow on SATS Green on SATS …”

Section: Discussionmentioning

confidence: 99%

Vital signs for children at triage: A multicentre validation of the revised South African Triage Scale (SATS) for children

et al. 2013

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Objective. To validate a revised version of the paediatric South African Triage Scale (SATS) against admission as a reference standard and compare the sensitivity of triage using: (i) clinical discriminators; (ii) an age-appropriate physiological composite score; and (iii) a combination of both. Methods. A prospective cohort study was undertaken validating the revised paediatric SATS against outcome markers of children at six emergency centres during a 2-month period in 2011. The primary outcome marker was the proportion of children admitted. Validity indicators including sensitivity (Se), specificity, positive predictive value and negative predictive value (NPV) were used to estimate the validity. Associated percentages for over-/under-triage were used to further assess practical application of the paediatric SATS. Results. A total of 2 014 children were included. The percentage of hospital admissions increased with an increase in the level of urgency from 5% in the non-urgent patients to 73% in the emergency patients. The data demonstrated that sensitivity increased substantially when using the SATS, which is a combination of clinical discriminators and the Triage Early Warning Score (TEWS) (Se 91.0%, NPV 95.3%), compared with use of clinical discriminators in isolation (Se 57.1%, NPV 86.3%) or the TEWS in isolation (Se 75.6%, NPV 89.1%). Conclusion. The results of this study illustrate that the revised paediatric SATS is a safe and robust triage tool.

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“…As such, validity has been assessed using surrogate markers such as hospital admission, discharge and resource utilisation. [11] In LMICs, however, the use of these surrogate markers is difficult owing to poor record keeping, varying levels of clinical skills and limited resources. Previous studies in LMICs have instead attempted to assess the validity of a triage scale by comparing the triage ratings assigned by emergency department (ED) staff for a series of simulated cases against those obtained from an expert panel based on the panel's expert opinion.…”

mentioning

confidence: 99%

Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan

Dalwai

Twomey

Maïkéré³

et al. 2014

S Afr Med J

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Background. Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low-and middle-income countries this strategy is underused, under-resourced and poorly researched. Objective. To assess the inter-and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan. Methods. Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard. Results. Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 -0.85). The intrarater agreement was also high with 87% exact agreement (95% CI 67 -100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of overtriage did not exceed the acceptable threshold of 30 -50%. Under-triage was acceptable for all except emergency cases (66%). Conclusion. ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for 'very urgent' and 'routine' cases, importantly, it may under-triage 'emergency' cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed.

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Limitations in validating emergency department triage scales

Cited by 110 publications

References 15 publications

Validation of the Hong Kong Accident and Emergency Triage Guidelines

Validation of the Hong Kong Accident and Emergency Triage Guidelines

Vital signs for children at triage: A multicentre validation of the revised South African Triage Scale (SATS) for children

Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan

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