This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research article
Jean-Christophe Callahan
Centre Hospitalier du Mans
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3376-3982
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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 Kappa was measured at 0.51 (95% CI 0.30 – 0.70), and 0.67 (95% CI 0.42 – 0.91) for intra-rater reproducibility. 474 patients were recruited in the validity study, respectively 26 (5%), 50 (11%), 384 (81%) and 14 (3%) for triage levels 1 through 4. Spearman’s correlation coefficient between triage level and emergency department resource consumption was calculated at R = -0.41 (p<0.001). 111 patients were admitted to the hospital with an area under the ROC curve measured at 0.72. 8 patients were admitted to an intensive care or high dependency unit with an area under the ROC curve measured at 0.73.
Conclusions:Our study of a four-level severity score based triage scale finds intermediate results in terms of reliability and validity. Further improvements of the scale have to focus on better discriminating between moderately urgent and non-urgent patients.
Keywords
Triage, Triage scale, Severity scale, Emergency Department
Figure 1
Figure 2
Loading...
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 01 Nov, 2019
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
Learn more about our company.
This is a preprint. It has not completed peer review.
Research article
Jean-Christophe Callahan
Centre Hospitalier du Mans
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3376-3982
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 01 Nov, 2019
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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 Kappa was measured at 0.51 (95% CI 0.30 – 0.70), and 0.67 (95% CI 0.42 – 0.91) for intra-rater reproducibility. 474 patients were recruited in the validity study, respectively 26 (5%), 50 (11%), 384 (81%) and 14 (3%) for triage levels 1 through 4. Spearman’s correlation coefficient between triage level and emergency department resource consumption was calculated at R = -0.41 (p<0.001). 111 patients were admitted to the hospital with an area under the ROC curve measured at 0.72. 8 patients were admitted to an intensive care or high dependency unit with an area under the ROC curve measured at 0.73.
Conclusions:Our study of a four-level severity score based triage scale finds intermediate results in terms of reliability and validity. Further improvements of the scale have to focus on better discriminating between moderately urgent and non-urgent patients.
Figure 1
Figure 2
Loading...