A multicenter study on reliability and validity of a new triage system: the Triage Emergency Method version 2

Abstract

In Italy there are many triage guidelines and methods based on consensus. But, to our knowledge, there are few data on the reliability and predictive validity of triage systems adopted by Italian emergency departments. The Triage Emergency Method version 2 (TEM v2) is a new four-level in-hospital triage system. This paper presentes a before-and-after observational study performed using triage scenarios from June 2008 to September 2009 in 6 Italian emergency departments. Twelve nurses who received a 5-h training on TEM and a panel of experts on TEM assigned priority code to 66 scenarios. To test the inter-rater reliability among participants and the panel of experts (before and after the course), we used the weighted K statistic. We assessed the validity of TEM by calculating sensitivity, specificity and accuracy for predicting the reference standard’s triage score. The TEM v2 showed good and very-good agreement among all 6 groups of nurses with a K range=0.61-1. Also, sensitivity, specificity and accuracy of nurses’ triage rating for predicting the reference standard’s triage code was good (accuracy range=78-90%). In this multicenter study, TEM v2 has a good inter-rater reliability for rating triage acuity among all groups of participating nurses, with a K value similar to the reference standard reliability (K=0.75). Thus, the Triage Emergency Method version 2 seems to be valid and accurate in predicting a reference standard rating.

Keywords

• triage, emergency department, reliability, predictive validity