Limitations in validating emergency department triage scales

Data were collected in aggregate fashion to test the inclusiveness and performance of the chosen indicators.Multiple indicators were classified as CC #1, #2, and #3.Triage in this hospital was routinely performed by an experienced group of ED nurses who had been given CTAS training in the past and had national CTAS Guidelines materials including the CEDIS Chief Complaint list, a validated set of chief complaints for ED triage [8].

Similar five-level systems are used in the United States, the United Kingdom, and Australia as well as in other jurisdictions.The NR retrospectively triaged two separate month’s ED charts one year apart blinded to physician data and triage score.The second data collection was performed one year later to determine the reproducibility of results after staff turnover occurred (approximately 25% of triage staff). We identified five key clinical indicators which captured over 60% of visits. Interobserver reliability and accuracy were compared using Kappa and comparative statistics. Clinical Indicators “pain scale, chest pain, musculoskeletal injury, respiratory illness, and headache” captured 68% and 62% of visits. We have demonstrated a system to measure the levels of process accuracy and reliability for triage over time.

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