Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-22T20:27:13.570Z Has data issue: false hasContentIssue false
  • English
  • Français

Inter-observer agreement using the Canadian Emergency Department Triage and Acuity Scale

Published online by Cambridge University Press:  21 May 2015

Daria Manos ,
David A. Petrie ,
Robert C. Beveridge ,
Stephen Walter  and
James Ducharme
Daria Manos
Affiliation:
Faculty of Medicine, Dalhousie University, Halifax, NS
David A. Petrie*
Affiliation:
Faculty of Medicine, Dalhousie University, Halifax, NS Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS
Robert C. Beveridge
Affiliation:
Faculty of Medicine, Dalhousie University, Halifax, NS Department of Emergency Medicine, Saint John Regional Hospital Facility, Saint John, NB
Stephen Walter
Affiliation:
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Hamilton, Ont
James Ducharme
Affiliation:
Faculty of Medicine, Dalhousie University, Halifax, NS Department of Emergency Medicine, Saint John Regional Hospital Facility, Saint John, NB
*
Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, 1796 Summer St., Halifax NS B3H 3A7; fax 902 494-1625; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To determine the inter-observer agreement on triage assignment by first-time users with diverse training and background using the Canadian Emergency Department Triage and Acuity Scale (CTAS).

Methods:

Twenty emergency care providers (5 physicians, 5 nurses, 5 Basic Life Support paramedics and 5 Advanced Life Support paramedics) at a large urban teaching hospital participated in the study. Observers used the 5-level CTAS to independently assign triage levels for 42 case scenarios abstracted from actual emergency department patient presentations. Case scenarios consisted of vital signs, mode of arrival, presenting complaint and verbatim triage nursing notes. Participants were not given any specific training on the scale, although a detailed one-page summary was included with each questionnaire. Kappa values with quadratic weights were used to measure agreement for the study group as a whole and for each profession.

Results:

For the 41 case scenarios analyzed, the overall agreement was significant (quadratic-weighted κ = 0.77, 95% confidence interval, 0.76–0.78). For all observers, modal agreement within one triage level was 94.9%. Exact modal agreement was 63.4%. Agreement varied by triage level and was highest for Level I (most urgent). A reasonably high level of intra- and inter-professional agreement was also seen.

Conclusions:

Despite minimal experience with the CTAS, inter-observer agreement among emergency care providers with different backgrounds was significant.

Keywords

triageparamedicsemergency medical services
Type
Em Advances • Progrès de la MU
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 1 , January 2002 , pp. 16 - 22
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Harden, RD.Critical appraisal of papers describing triage systems. Acad Emerg Med 1999;6:1166–71.Google Scholar
2.Williams, RM.Triage and emergency department services. Ann Emerg Med 1996;27:506–8.CrossRefGoogle ScholarPubMed
3.Brillman, JC, Doezema, D, Tandberg, D, Sklar, DP, Davis, KD, Simms, S.Triage: limitations in predicting need for emergent care and hospital admission. Ann Emerg Med 1996;27:493–500.CrossRefGoogle ScholarPubMed
4.Gill, JM, Reese, CL, Diamond, JJ.Disagreement among health care professionals about the urgent care needs of emergency department patients. Ann Emerg Med 1996;28:474–8.CrossRefGoogle ScholarPubMed
5.Read, S, George, S, Westlake, L, Williams, B, Glasgow, J, Potter, T.Piloting an evaluation of triage. Int J Nurs Stud 1992;29(3): 275–88.CrossRefGoogle ScholarPubMed
6.George, S, Read, S, Westlake, L, Fraser-Moodie, A, Pritty, P, Williams, B.Differences in priorities assigned to patients by triage nurses and by consultant physicians in accident and emergency departments. J Epidemiol Commun Health 1993;47:312–5.CrossRefGoogle ScholarPubMed
7.Beveridge, R. CAEP issues. The Canadian Triage and Acuity Scale: a new and critical element in health care reform. Canadian Association of Emergency Physicians. J Emerg Med 1998;16(3):507–11.Google Scholar
8.Cleary, MI, Ashby, RH, Jelinek, GA, Lagaida, R. The future of casemix in emergency medicine and ambulatory care. Med J Aust 1994;161(Suppl):S30–3.Google Scholar
9.Australasian College for Emergency Medicine. The Australasian Triage Scale [policy document]. Emerg Med 1994;6:145–6. Also available: www.acem.org.au/open/documents/triage.htm (accessed 2001 Nov 27).Google Scholar
10.Beveridge, R.The president’s letter. CAEP Communiqué 1995;Apr:1.Google Scholar
11.Derlet, RW, Nishio, DA.Refusing care to patients who present to an emergency department. Ann Emerg Med 1990;19:262–7.CrossRefGoogle ScholarPubMed
12.Derlet, RW, Kinser, D, Ray, L, Hamilton, B, McKenzie, J.Prospective identification and triage of nonemergency patients out of an emergency department: a 5-year study. Ann Emerg Med 1995;25:215–23.Google Scholar
13.Lowe, PA, Bindman, AB, Ulrich, SK, Norman, G, Scaletta, TA, Keane, D, el al. Failure to validate a predictive model for refusal of care to emergency department patients. Acad Emerg Med 1994;1:213–7.Google Scholar
14.Beveridge, R, Clarke, B, Janes, L, Savage, N, Thompson, J, Dodd, G, et al. Canadian Emergency Department Triage and Acuity Scale implementation guidelines. CJEM 1999;1(3 Suppl).Google Scholar
15.Jelinek, G, Little, M.Interrater reliability of the National Triage Scale. Emerg Med 1996;8:226–30.CrossRefGoogle Scholar
16.Beveridge, R, Ducharme, J, Janes, L, Beaulieu, S, Walter, S.Reliability of the Canadian emergency department triage and acuity scale: interrater agreement. Ann Emerg Med 1999;34:155–9.CrossRefGoogle ScholarPubMed
17.Landis, J, Koch, G.The measurement of observer agreement for categorical data. Biometrics 1977;33:159–74.CrossRefGoogle ScholarPubMed
18.Fleiss, J.Statistical methods for rates and proportions. 2nd ed. New York (NY): Wiley; 1981.Google Scholar
19.Holman, CD.Analysis of interobserver variation on a programmable calculator. Am J Epidemiol 1984;120:154–60.CrossRefGoogle ScholarPubMed
20.Butler, WR.ED patient classification matrix: development and testing of one tool. J Emerg Nursing 1986;12:279–85.Google Scholar
21.Brillman, JC, Doezema, D, Tandberg, D, Sklar, DP, Skipper, BJ.Does a physician visual assessment change triage? Am J Emerg Med 1997;15:29–33.CrossRefGoogle ScholarPubMed
22.Neely, KW, Drake, ME, Moorhead, JC, Schmidt, TA, Skeen, DT, Wilson, EA.Multiple options and unique pathways: A new direction for EMS? Ann Emerg Med 1997;30:797–9.CrossRefGoogle ScholarPubMed
23.Neely, KW.Ambulance transports: What are the alternatives? Acad Emerg Med 1997;4:1137–41.CrossRefGoogle ScholarPubMed