Reliability and validity of triage systems in paediatric emergency care

Table 1 Studies on reliability of the ESI, CTAS, MTS and ATS in paediatric emergency care

Country	N scenarios, raters (response rate)*	Triage system/population	Study design	Results ^‡
Australia [34]	14 scenarios, 178 nurses**	ATS, children	7 paper, 7 computer based scenarios	K 0.40 (paper) K 0.58 (computer)
Australia [35]	8 scenarios, 97 nurses (44%)	ATS, children	Written case scenarios	K 0.21
USA [6]	20 scenarios^†	ESI version 3, children	Written case scenarios	K_w 0.84–1.00
USA [6]	272 patients	ESI version 3, children	Simultaneous triage	K_w 0.59 (95% CI 0.55–0.63)
Canada [9]	54 scenarios, 18 nurses (62%)	PaedCTAS children	Written case scenarios	K_w 0.51 (95% CI 0.50–0.52)
Canada [10]	499 patients	PaedCTAS children	Simultaneous triage	Lineair K_w 0.55 (95% CI 0.48–0.61) Quadratic K_w 0.61 (95% CI 0.42–0.80)
The Netherlands [15]	50 scenarios, 48 nurses (87%)	MTS adults and children	Written case scenarios	K_w 0.62
The Netherlands [17]	20 scenarios, 43 nurses (100%) 198 patients	MTS in children	Written case scenarios Simultaneous triage	Quadratic K_w 0.83 (95% CI 0.74–0.91) Quadratic K_w 0.65 (95% CI 0.56–0.72)

* For studies using the written case scenario method
** Compliance rate not described in paper † N raters and compliance rate not described in paper
‡ K kappa, K_w Weighted kappa,
ATS = Australasian Triage Scale, ESI = Emergency Severity Index, MTS = Manchester Triage System, PaedCTAS = Paediatric Canadian Triage and Acuity Scale
Kappa/weighted kappa: poor if K ≤ 0.20, Fair if 0.21 ≤ K ≤ 0.40, moderate if 0.41 ≤ K ≤ 0.60, good if 0.61 ≤ K ≤ 0.80 very good if K>0.80. (95% confidence interval)

ISSN: 1757-7241