THE RELIABILITY AND ACCURACY OF INTERNATIONAL TRIAGE SCALE IN THE EMERGENCY DEPARTMENT (ED): A LITERATURE REVIEW
Keywords:
Accuracy, emergency department, reliability, triage scale
Abstract
A large number of patient visits to the Emergency Department (ED) will influence the outcome of the services provided. The triage scale is one method designed to manage patient screening for quality service improvement. Several triage scales are employed internationally in the EDs including the Australasian Triage Scale (ATS), the Manchester Triage System (MTS), the Canadian Triage and Accuracy Scale (CTAS), and the Emergency Severity Index (ESI). Several studies have a concern to identify the reliability of the triage scale, but only a few of them identified the accuracy of the triage scale. The purpose of this literature review was to identify the best reliability and accuracy among ATS, MTS, CTAS, and ESI based on the literature. The literature search was conducted on electronic databases EBSCO and PubMed with keywords including (triage OR emergency department triage) AND reliability AND ((the Canadian Triage and Accuracy Scale OR CTAS) AND (the Australasian Triage Scale OR ATS) AND (the Manchester Triage System OR MTS) AND the Emergency Severity Index OR ESI)). Assessment of articles was composed based on the PRISMA format with criteria including primary research articles containing the reliability and accuracy of the triage scale in English and published between 2009 – 2019. A total of 271 publications were identified and only 10 studies were included in this literature review. The results reveal that ATS has a moderate level of reliability (k = 04 – 0.57) with an accuracy of 46.2% – 58.3%, CTAS has a good level reliability (k = 0.770) with accuracy of 49%, MTS have good to excellent level of reliability (k = 0.61 – 0.95) with accuracy of 49%, and ESI have moderate to excellent level reliability (k = 0.45 – 0.94) with accuracy of 59.6 % – 72.5%. Based on this review, MTS and ESI are the triage scale with the highest reliability and accuracy. Therefore, MTS and ESI are highly recommended in the ED. However, each EDs need to pay attention to the characteristics, culture, and available resources before choosing and implementing an appropriate triage scale
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References
Agency for Healthcare Research and Quality. (2012). Emergency severity index (ESI): A triage tool for emergency department care version 4. Retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/esi/esihandbk.pdf
Alquraini, M., Awad, E., & Hijazi, R. (2015). Reliability of Canadian Emergency Department Triage and Acuity Scale (CTAS) in Saudi Arabia. International journal of emergency medicine, 8(1), 80. doi:10.1186/ s12245-015-0080-5
Andrade-Silva, F. B., Takemura, R. L., Bellato, R. T., Leonhardt, M. D. C., & Kojima, K. E., et al. (2019). Validity and reliability of the Manchester scale used in the orthopedic emergency department. Acta Ortopedica Brasileira, 27(1), 50–54. https:// doi.org/10.1590/1413-785220192701191577
Australasian College For Emergency Medicine. (2016). Guidelines on the Implementation of the ATS in Emergency Departments, pp. 1–8. Melbourne: Australasian College For Emergency Medicine.
Brouns, S. H. A., Mignot-Evers, L., Derkx, F., Lambooij, S. L., & Dieleman, J. P., et al. (2019). Performance of the Manchester triage system in older emergency department patients: A retrospective cohort study. BMC Emergency Medicine, 19(1), 1–12. https:// doi.org/10.1186/s12873-018-0217-y
Canadian Association of Emergency Physicians. (2013). Applying CTAS to adults. Retrieved from http://www.qehaedbb.org/ wp-content/uploads/2018/03/2011_-_CTAS_ Module_2_Notes.pdf
Chong, A., & Romkey, L. (2017). Testing Inter-Rater Reliability in Rubrics for Large Scale Undergraduate Independent Projects. Proceedings of the Canadian Engineering Education Association (CEEA), pp. 1–9.
Christ, M., Grossmann, F., Winter, D., Bingisser, R., & Platz, E. (2010). Modern Triage in the Emergency Department. Deutsches Ärzteblatt International, 107(50), 892–898. https://doi.org/10.3238/ arztebl.2010.0892
Dippenaar, E. (2016). Standardisation and validation of a triage system in a private hospital group in the United Arab Emirates (Doctoral dissertation). University of Cape Town.
Dippenaar, E., & Bruijns, S. (2016). Triage is easy, said no triage nurse ever. International Emergency Nursing, 29, 1–2. https://doi. org/10.1016/j.ienj.2016.09.005
Ekins, K., & Morphet, J. (2015). The accuracy and consistency of rural, remote and outpost triage nurse decision making in one Western Australia Country Health Service Region. Australasian Emergency Nursing Journal. https://doi.org/10.1016/j.aenj.2015.05.002
Esmailian, M., Zamani, M., Azadi, F., & Ghasemi, F. (2014). Inter-Rater Agreement of Emergency Nurses and Physicians in Emergency Severity Index (ESI) Triage. Emergency (Tehran, Iran), 2(4), 158– 15861. https://doi.org/10.22037/emergency. v2i4.6449
FitzGerald, G., Jelinek, G. A., Scott, D., & Gerdtz, M. F. (2010). Emergency department triage revisited. Emergency Medicine Journal, 27(2), 86–92. https://doi.org/10.1136/ emj.2009.077081
Fry, M., & Burr, G. (2002). Review of the triage literature: Past, present, future? Australian Emergency Nursing Journal, 5(2), 33–38. doi:10.1016/s1328-2743(02)80018-9
Gräff, I., Goldschmidt, B., Glien, P., Bogdanow, M., Fimmers, R., & Hoeft, A., et al. (2014). The German version of the Manchester triage system and its quality criteria - First assessment of validity and reliability. PLoS ONE, 9(2), 1–12. https:// doi.org/10.1371/journal.pone.0088995
Hallgren, K. A. (2012). Computing inter-rater reliability for observational data: An overview and tutorial. Tutorial Quantitative Methods Psychology, 8(1), 23–34. https:// doi.org/10.1093/carcin/9.8.1355
Health Policy Priorities Principal Committee. (2011). Australian triage process review. Adelaide: Health Policy Priorities Principal Committee.
Hinson, J. S., Martinez, D. A., Schmitz, P. S. K., Toerper, M., & Radu, D., et al. (2018). Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. International Journal of Emergency Medicine, 11(1), 3. https://doi.org/10.1186/ s12245-017-0161-8
Hodge, A., Hugman, A., Varndell, W., & Howes, K. (2013). A review of the quality assurance processes for the Australasian Triage Scale (ATS) and implications for future practice. Australasian Emergency Nursing Journal, 16, 21–29. https://doi.org/10.1016/j. aenj.2012.12.003
Iserson, K. V., & Moskop, J. C. (2007). Triage in Medicine, Part I: Concept, History, and Types. Annals of Emergency Medicine, 49(3), 275–281. https://doi.org/10.1016/j. annemergmed.2006.05.019
Jordi, K., Grossmann, F., Gaddis, G. M., Cignacco, E., & Denhaerynck, R., et al. (2015). Nurses’ accuracy and self-perceived ability using the Emergency Severity Index triage tool: A cross-sectional study in four Swiss hospitals. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23(1). https://doi.org/10.1186/ s13049-015-0142-y
Lampi, M. (2018). Triage Management of the Trauma Patient. Linköping University Medical Dissertations (Vol. 32). https://doi. org/10.1186/s13049-014-0050-6
Manchester Triage Group. (2014). Emergency Triage. Third edition (3rd ed.; K. Mackway-Jones, J. Marsden, & J. Windle, eds.). West Sussex: John Wiley & Sons, Ltd.
Mirhaghi, A., Heydari, A., Mazlom, R., & Hasanzadeh, F. (2015). Reliability of the emergency severity index: Meta-analysis. Sultan Qaboos University Medical Journal, 15(1), e71–e77.
Mirhaghi, A., Kooshiar, H., Esmaeili, H., & Ebrahimi, M. (2015). Outcomes for emergency severity index triage implementation in the emergency department. Journal of Clinical and Diagnostic Research, 9(4), OC04-OC07. https://doi.org/10.7860/ JCDR/2015/11791.5737
Monash Institute of Health Services Research. (2001). Consistency of Triage in Victoria’s Emergency Departments: Guidelines for Triage Education and Practice. Victoria: Monash Institute of Health Services Research
Olofsson, P., Gellerstedt, M., & Carlström, E. D. (2009). Manchester Triage in Sweden - Interrater reliability and accuracy. International Emergency Nursing, 17(3), 143–148. https://doi.org/10.1016/j. ienj.2008.11.008
Parenti, N., Reggiani, M. L. B., Iannone, P., Percudani, D., & Dowding, D. (2014). A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System. International Journal of Nursing Studies, 51(2014), 1062–1069. https://doi. org/10.1016/j.ijnurstu.2014.01.013
Qureshi, N. A. (2010). Triage systems: a review of the literature with reference to Saudi Arabia. Eastern Mediterranean Health Journal, 16(6), 690–698. https://doi. org/10.26719/2010.16.6.690
Qureshi, N. A. (2010). Triage systems: a review of the literature with reference to Saudi Arabia. Eastern Mediterranean Health Journal, 16(6), 690–698. https://doi. org/10.26719/2010.16.6.690
Saeed, A. Bin, Al-Fayyadh, F. M., Alshomar, K. M., Zekry, Z. W., & Alamiri, N. N., et al. (2017). Validating the Implementation of the Triage System in an Emergency Department in a University Hospital. Journal of Health Specialties, 5, 73–79. https://doi.org/10.4103/ jhs.JHS
Souza, C. C. de, Chianca, T. C. M., Júnior, W. C., Rausch, M. do C. P., & Nascimento, G. F. L. (2018). Reliability analysis of the manchester triage system: Inter-observer and intra-observer agreement. Revista Latino-Americana de Enfermagem, 26. https://doi. org/10.1590/1518-8345.2205.3005
Storm-Versloot, M. N., Ubbink, D. T., Kappelhof, J., & Luitse, J. S. K. (2011). Comparison of an Informally Structured Triage System, the Emergency Severity Index, and the Manchester Triage System to Distinguish Patient Priority in the Emergency Department. Academic Emergency Medicine, 18(8), 822–829. https://doi.org/10.1111/ j.1553-2712.2011.01122.x
Twomey, M. (2011). Performance characteristics of the South African Triage Scale (Adult Version) (Doctoral dissertation). School of Public Health and Family Medicine University of Cape Town.
Varndell, W., Hodge, A., Ryan, E., & Fry, M. (2019). The use and feasibility of an online software system to support assessment of accuracy and consistency in applying the Australasian Triage Scale. Australasian Emergency Care. 10.1016/j. auec.2019.06.003.
Yuksen, C., Sawatmongkornkul, S., Suttabuth, S., Sawanyawisuth, K., & Sittichanbuncha, Y. (2016). Emergency severity index compared with 4-level triage at the emergency department of Ramathibodi University Hospital. Asian Biomedicine, 10(2), 155–161. https://doi.org/10.5372/1905-7415.1002.477
Alquraini, M., Awad, E., & Hijazi, R. (2015). Reliability of Canadian Emergency Department Triage and Acuity Scale (CTAS) in Saudi Arabia. International journal of emergency medicine, 8(1), 80. doi:10.1186/ s12245-015-0080-5
Andrade-Silva, F. B., Takemura, R. L., Bellato, R. T., Leonhardt, M. D. C., & Kojima, K. E., et al. (2019). Validity and reliability of the Manchester scale used in the orthopedic emergency department. Acta Ortopedica Brasileira, 27(1), 50–54. https:// doi.org/10.1590/1413-785220192701191577
Australasian College For Emergency Medicine. (2016). Guidelines on the Implementation of the ATS in Emergency Departments, pp. 1–8. Melbourne: Australasian College For Emergency Medicine.
Brouns, S. H. A., Mignot-Evers, L., Derkx, F., Lambooij, S. L., & Dieleman, J. P., et al. (2019). Performance of the Manchester triage system in older emergency department patients: A retrospective cohort study. BMC Emergency Medicine, 19(1), 1–12. https:// doi.org/10.1186/s12873-018-0217-y
Canadian Association of Emergency Physicians. (2013). Applying CTAS to adults. Retrieved from http://www.qehaedbb.org/ wp-content/uploads/2018/03/2011_-_CTAS_ Module_2_Notes.pdf
Chong, A., & Romkey, L. (2017). Testing Inter-Rater Reliability in Rubrics for Large Scale Undergraduate Independent Projects. Proceedings of the Canadian Engineering Education Association (CEEA), pp. 1–9.
Christ, M., Grossmann, F., Winter, D., Bingisser, R., & Platz, E. (2010). Modern Triage in the Emergency Department. Deutsches Ärzteblatt International, 107(50), 892–898. https://doi.org/10.3238/ arztebl.2010.0892
Dippenaar, E. (2016). Standardisation and validation of a triage system in a private hospital group in the United Arab Emirates (Doctoral dissertation). University of Cape Town.
Dippenaar, E., & Bruijns, S. (2016). Triage is easy, said no triage nurse ever. International Emergency Nursing, 29, 1–2. https://doi. org/10.1016/j.ienj.2016.09.005
Ekins, K., & Morphet, J. (2015). The accuracy and consistency of rural, remote and outpost triage nurse decision making in one Western Australia Country Health Service Region. Australasian Emergency Nursing Journal. https://doi.org/10.1016/j.aenj.2015.05.002
Esmailian, M., Zamani, M., Azadi, F., & Ghasemi, F. (2014). Inter-Rater Agreement of Emergency Nurses and Physicians in Emergency Severity Index (ESI) Triage. Emergency (Tehran, Iran), 2(4), 158– 15861. https://doi.org/10.22037/emergency. v2i4.6449
FitzGerald, G., Jelinek, G. A., Scott, D., & Gerdtz, M. F. (2010). Emergency department triage revisited. Emergency Medicine Journal, 27(2), 86–92. https://doi.org/10.1136/ emj.2009.077081
Fry, M., & Burr, G. (2002). Review of the triage literature: Past, present, future? Australian Emergency Nursing Journal, 5(2), 33–38. doi:10.1016/s1328-2743(02)80018-9
Gräff, I., Goldschmidt, B., Glien, P., Bogdanow, M., Fimmers, R., & Hoeft, A., et al. (2014). The German version of the Manchester triage system and its quality criteria - First assessment of validity and reliability. PLoS ONE, 9(2), 1–12. https:// doi.org/10.1371/journal.pone.0088995
Hallgren, K. A. (2012). Computing inter-rater reliability for observational data: An overview and tutorial. Tutorial Quantitative Methods Psychology, 8(1), 23–34. https:// doi.org/10.1093/carcin/9.8.1355
Health Policy Priorities Principal Committee. (2011). Australian triage process review. Adelaide: Health Policy Priorities Principal Committee.
Hinson, J. S., Martinez, D. A., Schmitz, P. S. K., Toerper, M., & Radu, D., et al. (2018). Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. International Journal of Emergency Medicine, 11(1), 3. https://doi.org/10.1186/ s12245-017-0161-8
Hodge, A., Hugman, A., Varndell, W., & Howes, K. (2013). A review of the quality assurance processes for the Australasian Triage Scale (ATS) and implications for future practice. Australasian Emergency Nursing Journal, 16, 21–29. https://doi.org/10.1016/j. aenj.2012.12.003
Iserson, K. V., & Moskop, J. C. (2007). Triage in Medicine, Part I: Concept, History, and Types. Annals of Emergency Medicine, 49(3), 275–281. https://doi.org/10.1016/j. annemergmed.2006.05.019
Jordi, K., Grossmann, F., Gaddis, G. M., Cignacco, E., & Denhaerynck, R., et al. (2015). Nurses’ accuracy and self-perceived ability using the Emergency Severity Index triage tool: A cross-sectional study in four Swiss hospitals. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23(1). https://doi.org/10.1186/ s13049-015-0142-y
Lampi, M. (2018). Triage Management of the Trauma Patient. Linköping University Medical Dissertations (Vol. 32). https://doi. org/10.1186/s13049-014-0050-6
Manchester Triage Group. (2014). Emergency Triage. Third edition (3rd ed.; K. Mackway-Jones, J. Marsden, & J. Windle, eds.). West Sussex: John Wiley & Sons, Ltd.
Mirhaghi, A., Heydari, A., Mazlom, R., & Hasanzadeh, F. (2015). Reliability of the emergency severity index: Meta-analysis. Sultan Qaboos University Medical Journal, 15(1), e71–e77.
Mirhaghi, A., Kooshiar, H., Esmaeili, H., & Ebrahimi, M. (2015). Outcomes for emergency severity index triage implementation in the emergency department. Journal of Clinical and Diagnostic Research, 9(4), OC04-OC07. https://doi.org/10.7860/ JCDR/2015/11791.5737
Monash Institute of Health Services Research. (2001). Consistency of Triage in Victoria’s Emergency Departments: Guidelines for Triage Education and Practice. Victoria: Monash Institute of Health Services Research
Olofsson, P., Gellerstedt, M., & Carlström, E. D. (2009). Manchester Triage in Sweden - Interrater reliability and accuracy. International Emergency Nursing, 17(3), 143–148. https://doi.org/10.1016/j. ienj.2008.11.008
Parenti, N., Reggiani, M. L. B., Iannone, P., Percudani, D., & Dowding, D. (2014). A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System. International Journal of Nursing Studies, 51(2014), 1062–1069. https://doi. org/10.1016/j.ijnurstu.2014.01.013
Qureshi, N. A. (2010). Triage systems: a review of the literature with reference to Saudi Arabia. Eastern Mediterranean Health Journal, 16(6), 690–698. https://doi. org/10.26719/2010.16.6.690
Qureshi, N. A. (2010). Triage systems: a review of the literature with reference to Saudi Arabia. Eastern Mediterranean Health Journal, 16(6), 690–698. https://doi. org/10.26719/2010.16.6.690
Saeed, A. Bin, Al-Fayyadh, F. M., Alshomar, K. M., Zekry, Z. W., & Alamiri, N. N., et al. (2017). Validating the Implementation of the Triage System in an Emergency Department in a University Hospital. Journal of Health Specialties, 5, 73–79. https://doi.org/10.4103/ jhs.JHS
Souza, C. C. de, Chianca, T. C. M., Júnior, W. C., Rausch, M. do C. P., & Nascimento, G. F. L. (2018). Reliability analysis of the manchester triage system: Inter-observer and intra-observer agreement. Revista Latino-Americana de Enfermagem, 26. https://doi. org/10.1590/1518-8345.2205.3005
Storm-Versloot, M. N., Ubbink, D. T., Kappelhof, J., & Luitse, J. S. K. (2011). Comparison of an Informally Structured Triage System, the Emergency Severity Index, and the Manchester Triage System to Distinguish Patient Priority in the Emergency Department. Academic Emergency Medicine, 18(8), 822–829. https://doi.org/10.1111/ j.1553-2712.2011.01122.x
Twomey, M. (2011). Performance characteristics of the South African Triage Scale (Adult Version) (Doctoral dissertation). School of Public Health and Family Medicine University of Cape Town.
Varndell, W., Hodge, A., Ryan, E., & Fry, M. (2019). The use and feasibility of an online software system to support assessment of accuracy and consistency in applying the Australasian Triage Scale. Australasian Emergency Care. 10.1016/j. auec.2019.06.003.
Yuksen, C., Sawatmongkornkul, S., Suttabuth, S., Sawanyawisuth, K., & Sittichanbuncha, Y. (2016). Emergency severity index compared with 4-level triage at the emergency department of Ramathibodi University Hospital. Asian Biomedicine, 10(2), 155–161. https://doi.org/10.5372/1905-7415.1002.477
Published
2024-06-06
How to Cite
Parinding, Y. (2024). THE RELIABILITY AND ACCURACY OF INTERNATIONAL TRIAGE SCALE IN THE EMERGENCY DEPARTMENT (ED): A LITERATURE REVIEW. Jurnal Ilmiah Kesehatan Promotif, 8(2), 1-15. https://doi.org/10.56437/jikp.v8i2.154
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