Reliability of the revised Swiss Emergency Triage Scale: a computer simulation study - Rutschmann, O. T.; Hugli, O. W.; Marti, C.; Grosgurin, O.; Geissbuhler, A.; Kossovsky, M.; Simon, J.; Sarasin, F. P. (Eur J Emerg Med, 2017)
BACKGROUND: The Swiss Emergency Triage Scale (SETS) is a four-level emergency scale that previously showed moderate reliability and high rates of undertriage due to a lack of standardization. It was revised to better standardize the measurement and interpretation of vital signs during the triage process. OBJECTIVE: The aim of this study was to explore the inter-rater and test-retest reliability, and the rate of correct triage of the revised SETS. PATIENTS AND METHODS: Thirty clinical scenarios were evaluated twice at a 3-month interval using an interactive computerized triage simulator by 58 triage nurses at an urban teaching emergency department admitting 60 000 patients a year. Inter-rater and test-retest reliabilities were determined using kappa statistics. Triage decisions were compared with a gold standard attributed by an expert panel. Rates of correct triage, undertriage, and overtriage were computed. A logistic regression model was used to identify the predictors of correct triage. RESULTS: A total of 3387 triage situations were analyzed. Inter-rater reliability showed substantial agreement [mean kappa: 0.68; 95% confidence interval (CI): 0.60-0.78] and test-retest almost perfect agreement (mean kappa: 0.86; 95% CI: 0.84-0.88). The rate of correct triage was 84.1%, and rates of undertriage and overtriage were 7.2 and 8.7%, respectively. Vital sign measurement was an independent predictor of correct triage (odds ratios for correct triage: 1.29 for each additional vital sign measured, 95% CI: 1.20-1.39). CONCLUSION: The revised SETS incorporating standardized vital sign measurement and interpretation during the triage process resulted in high reliability and low rates of mistriage.
Keywords: journalArticle; *Clinical Competence; *Computer Simulation; Critical Illness/therapy; Emergency Nursing/*methods; Emergency Service, Hospital/*statistics & numerical data; Female; Hospitals, Teaching; Humans; Logistic Models; Male; Observer Variation; Prospective Studies; Switzerland; Triage/*methods; Vital Signs