REVIEW Open Access Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence (original) (raw)
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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2011
Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed:
Majalah Keperawatan Unpad, 2020
A large number of patient visits to the Emergency Department (ED) will influence the outcome of the services provided. The triage scale is one method designed to manage patient screening for quality service improvement. Several triage scales are employed internationally in the EDs including the Australasian Triage Scale (ATS), the Manchester Triage System (MTS), the Canadian Triage and Accuracy Scale (CTAS), and the Emergency Severity Index (ESI). Several studies have a concern to identify the reliability of the triage scale, but only a few of them identified the accuracy of the triage scale. The purpose of this literature review was to identify the best reliability and accuracy among ATS, MTS, CTAS, and ESI based on the literature. The literature search was conducted on electronic databases EBSCO and PubMed with keywords including (triage OR emergency department triage) AND reliability AND ((the Canadian Triage and Accuracy Scale OR CTAS) AND (the Australasian Triage Scale OR ATS) AND (the Manchester Triage System OR MTS) AND the Emergency Severity Index OR ESI)). Assessment of articles was composed based on the PRISMA format with criteria including primary research articles containing the reliability and accuracy of the triage scale in English and published between 2009-2019. A total of 271 publications were identified and only 10 studies were included in this literature review. The results reveal that ATS has a moderate level of reliability (k = 04-0.57) with an accuracy of 46.2%-58.3%, CTAS has a good level reliability (k = 0.770) with accuracy of 49%, MTS have good to excellent level of reliability (k = 0.61-0.95) with accuracy of 49%, and ESI have moderate to excellent level reliability (k = 0.45-0.94) with accuracy of 59.6 %-72.5%. Based on this review, MTS and ESI are the triage scale with the highest reliability and accuracy. Therefore, MTS and ESI are highly recommended in the ED. However, each EDs need to pay attention to the characteristics, culture, and available resources before choosing and implementing an appropriate triage scale.
Kappa Agreement of Emergency Department Triage Scales; A Systematic Review and Meta-Analysis
journal of clinical research & governanace
The aim of this review was to compare the reliability of existing triage scales. The research question was that, using kappa value as reliability measure, in adult ED patients to what extent did clinicians' triage ratings agree with eachother or with a gold standard? Methods: The search was limited to studies on adult patients (≥15 years) visiting EDs for somatic reasons and to English and Persian studies that have reported kappa. Studies solely on geriatric patients, computerized triage, telephone triage, and specialty triages were excluded. PubMed, Scopus, ISI web of knowledge, Mosby's Nursing Index, Magiran and SID, were systematically searched through August 2013. 13 articles for kappa (n=38829), 11 articles for linear weighted kappa (LWK) (n= 22697) and 12 articles for quadratic weighted kappa (QWK) (n=10915) met our inclusion criteria. Heterogeneity among studies and publication bias were checked. All pooled analyses of kappa scores for each triage scale were calculated based on random-effects model and then the scales were compared. Results: Findings suggest that five-level scales are more reliable in triaging patients in the emergency department than others (pooled kappa: 0.53, 95% CI (0.48, 0.57), LWK= 0.76, 95% CI (0.72, 0.81) and QWK = 0.74, 95% CI (0.69, 0.79)). The Canadian Triage and Acuity Scale (CTAS) and the Emergency Severity Index (ESI) have been studied more than the other scales. Conclusion: It seems necessary to set a consensus method to assess and compare the reliability of triage scales. This review suggests more specific studies on reliability of triage scales, especially on intra-rater agreement.
Reliability and validity of a four-level severity score based triage scale
2019
Background:Triage scales are essential tools for an early and rapid assessment of patients, by classifying them according to their degree of urgency. The objective of this study was to measure the reliability and validity of a four-level severity score based scale.Methods:To evaluate reliability, 250 triage forms were triaged by 6 triage nurses twice, 15 days apart. Intra and inter-rater reproducibility were measured using a weighted Cohen’s Kappa. For the validity study, 485 charts were evaluated. The relationship between triage level and emergency department resource consumption was measured using Spearman’s correlation coefficient. Prediction of severity was measured by the correlation between triage level and hospitalization in any ward, and between triage level and death in the emergency department or hospitalization in an intensive care or high dependency unit. Areas under the ROC curves were measured for these results.Results:For inter-rater reproducibility, the weighted Kapp...
Bulletin of Emergency & Trauma, 2020
Objective: To evaluate the accuracy of the five-level triage system using the emergency severity index (ESI) and to determine the compliance of the triage level with patient outcomes. Methods: This was a cross-sectional study which was performed in the emergency department of Imam Reza Hospital of Mashhad during 2017. We included all the adult patients (≥15 years of age) referring to the emergency department. The data were recorded in a questionnaire containing three sections including demographic information, results of triage by ESI and final outcome of the patient. Patients referred to the triage unit were simultaneously triaged by triage nurse and some emergency medicine physicians. The triage was performed by a nurse with an emergency medicine physician (EMP) was considered as a gold standard and the outcome was compared in 24 hours later. Results: Overall, we included 400 patients with a mean age of 46.40 ± 18.52 years among whom there were 211 (52.8%) men and 189 (47.3%) wome...
Limitations in validating emergency department triage scales
Emergency Medicine Journal, 2007
Objective: To examine whether current validation methods of emergency department triage scales actually assess the instrument's validity. Methods: Optimal methods of emergency department triage scale validation are examined in developed countries and their application to developing countries is considered. Results and conclusion: Numerous limitations are embedded in the process of validating triage scales. Methods of triage scale validation in developed countries may not be appropriate and repeatable in developing countries. Even in developed countries there are problems in conceptualising validation methods. A new consensus building validation approach has been constructed and recommended for a developing country setting. The Delphi method, a consensual validation process, is advanced as a more appropriate alternative for validating triage scales in developing countries.
2018
Introduction: Emergency department (ED) is usually the first line of healthcare supply to patients in non-urgent to critical situations and, if necessary, provides hospital admission. A dynamic system to evaluate patients and allocate priorities is necessary. Such a structure that facilitates patients' flow in the ED is termed triage. Objective: This study was conducted to investigate the validity and reliability of implementation of Emergency Severity Index (ESI) system version 4 by triage nurses in an overcrowded referral hospital with more than 80000 patient admissions per year and an average emergency department occupancy rate of more than 80%. Method: This prospective cross-sectional study was conducted in a tertiary care teaching hospital and trauma center with an emergency medicine residency program. Seven participating expert nurses were asked to assess the ESI level of patients in 30 written scenarios twice within a three-week interval to evaluate the inter-rater and intra-rater reliability. Patients were randomly selected to participate in the study, and the triage level assigned by the nurses was compared with that by the emergency physicians. Finally, based on the patients' charts, an expert panel evaluated the validity of the triage level. Results: During the study period, 527 patients with mean age of 54 ± 7 years, including 253 (48%) women and 274 (52%) men, were assessed by seven trained triage nurses. The degree of retrograde agreement between the collaborated expert panel's evaluation and the actual triage scales by the nurses and physicians for all 5 levels was excellent, with the Cohen's weighted kappa being 0.966 (CI 0.985–0.946, p < 0.001) and 0.813 (CI 0.856–0.769, p<0.001), respectively. The intra-rater reliability was 0.94 (p < 0.0001), and the inter-rater reliability for all the nurses was in perfect agreement with the test result (Cohen's weighted kappa were as follows: 0.919, 0.956, 0.911, 0.955, 0.860, 0.956, and 0.868; p < 0.001). Conclusion: The study findings showed that there was perfect reliability and, overall, almost perfect validity for the triage performed by the studied nurses.
2021
Background: Emergency Department (ED) physicians often need to quickly assess patients and determine vital signs to prioritize them by the severity of their condition and make optimal treatment decisions. Effective triage requires optimal scoring systems to accelerate and positively influence the treatment of trauma cases. To this end, a variety of scoring systems have been developed to enable rapid assessment of ED patients. The present systematic review and meta-analysis aimed to investigate the accuracy of the Rapid Emergency Medicine Score (REMS) system in predicting the mortality rate in non-surgical ED patients. Methods: A systematic search of articles published between 1990 and 2020 was conducted using various scientific databases (Medline, Embase, Scopus, Web of Science, ProQuest, Cochrane Library, IranDOC, Magiran, and Scientific Information Database). Both cross-sectional and cohort studies assessing the REMS system to predict mortality in ED settings were considered. Two ...
Introduction: Triage is one of the most important systems in patients prioritizing at the time of arrival to hospital. Based on the severity of the injury and the need for treatment, this system manages patients in the least time, which could lead to rotation of patients with high reliability and safety. Currently, the most accepted method for triage is emergency severity index (ESI) system, considered as five-level triage method, too. This method were implemented in Al Zahra Hospital of Isfahan by trained nurses since March to May 2010. This study was aimed to evaluate the accuracy of emergency nursing triage using ESI. Methods: This prospective cross sectional study was carried out on 601 patients referred to Al-Zahra hospital of Isfahan through May 2010. The patients' triage level were determined by physicians and nurses separately and the results compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. To specify t...
Journal of Nursing and Midwifery Sciences, 2016
Background and Purpose: The emergency severity index (ESI) triage system has been recommended by the Ministry of Health to classify patients at emergency departments. This study aimed to assess the validity of ESI system (version 4) in the emergency department of a teaching hospital. Outcome measures were hospitalization, emergency department (ED) length of stay, resource consumption, in-hospital mortality, and patient service costs. Methods: In this retrospective cross-sectional study, medical records of 562 ED patients were reviewed to determine the ESI level and outcome measures in April 2013. Possible correlations were assessed using Phi and Cramer's V and Spearman's Rho. Data analysis was performed in SPSS V.16, and P value of 0.05 was considered significant. Results: In this study, frequency of five ESI levels (1-5) was 24, 14, 365, 158 and 0, respectively. In addition, Phi and Cramer's V for hospitalization and mortality were 0.350 (P<0.001) and 0.345 (P<0.001), respectively. Spearman's Rho for patient service costs, ED length of stay, and resource consumption were-0.434 (P<0.001),-0.015 (P=0.362), and-0.411 (P<0.001), respectively. According to our findings, the association between triage levels and resource consumption was more significant compared to other outcome measures. Conclusion: According to the results of this study, ESI triage ratings could successfully predict patient outcomes in terms of hospitalization, in-hospital mortality, resource consumption, and patient service costs. Therefore, use of this valid triage system is recommended for the arrangement of human and physical resources at emergency departments.