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

Publication ,  Journal Article
Worster, A; Gilboy, N; Fernandes, CM; Eitel, D; Eva, K; Geisler, R; Tanabe, P
Published in: Canadian Journal of Emergency Medicine
January 1, 2004

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 five-level 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.

Duke Scholars

Published In

Canadian Journal of Emergency Medicine

DOI

ISSN

1481-8035

Publication Date

January 1, 2004

Volume

6

Issue

4

Start / End Page

240 / 245

Related Subject Headings

  • Emergency & Critical Care Medicine
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Worster, A., Gilboy, N., Fernandes, C. M., Eitel, D., Eva, K., Geisler, R., & Tanabe, P. (2004). Assessment of inter-observer reliability of two five-level triage and acuity scales: A randomized controlled trial. Canadian Journal of Emergency Medicine, 6(4), 240–245. https://doi.org/10.1017/S1481803500009192
Worster, A., N. Gilboy, C. M. Fernandes, D. Eitel, K. Eva, R. Geisler, and P. Tanabe. “Assessment of inter-observer reliability of two five-level triage and acuity scales: A randomized controlled trial.” Canadian Journal of Emergency Medicine 6, no. 4 (January 1, 2004): 240–45. https://doi.org/10.1017/S1481803500009192.
Worster A, Gilboy N, Fernandes CM, Eitel D, Eva K, Geisler R, et al. Assessment of inter-observer reliability of two five-level triage and acuity scales: A randomized controlled trial. Canadian Journal of Emergency Medicine. 2004 Jan 1;6(4):240–5.
Worster, A., et al. “Assessment of inter-observer reliability of two five-level triage and acuity scales: A randomized controlled trial.” Canadian Journal of Emergency Medicine, vol. 6, no. 4, Jan. 2004, pp. 240–45. Scopus, doi:10.1017/S1481803500009192.
Worster A, Gilboy N, Fernandes CM, Eitel D, Eva K, Geisler R, Tanabe P. Assessment of inter-observer reliability of two five-level triage and acuity scales: A randomized controlled trial. Canadian Journal of Emergency Medicine. 2004 Jan 1;6(4):240–245.
Journal cover image

Published In

Canadian Journal of Emergency Medicine

DOI

ISSN

1481-8035

Publication Date

January 1, 2004

Volume

6

Issue

4

Start / End Page

240 / 245

Related Subject Headings

  • Emergency & Critical Care Medicine
  • 3202 Clinical sciences
  • 1103 Clinical Sciences