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A comparison of a formal triage scoring system and a quick-look triage approach

Betz, Martin; Stempien, James; Wilde, Alan; Bryce, Rhonda

European Journal of Emergency Medicine: June 2016 - Volume 23 - Issue 3 - p 185–189
doi: 10.1097/MEJ.0000000000000239

Background Emergency Department (ED) triage systems have become increasingly comprehensive over time, requiring ever more resources such as nursing time and computer support. There are very few studies that have looked at whether this increased complexity results in improved performance.

Objectives This study looked at one aspect of performance, comparing reliability of triage nurses’ (TNs) triage scores utilizing a simple quick-look method with a commonly used, resource-intense, five-level triage system.

Methods This observational study of TNs was carried out in two urban tertiary-care hospital EDs, in real time, assessing patients arriving consecutively. Immediately upon patients’ arrival, TNs were asked to assign triage scores based simply on their observation of the patient and the chief complaint. The patient was then triaged in the department’s usual way, utilizing a computer-assisted five-level triage system [Canadian Triage and Acuity Scale (CTAS)]. Agreement between scores was quantified. κ scores were calculated, and weighted by the CTAS score.

Results A total of 496 triage assessments were included. Percent agreement between the quick-look method and the standard CTAS method was 84.5%. κ scores were moderately high. Fourteen patients (2.6%), ultimately classified as CTAS 1 or 2, initially received lower scores from TNs using the quick-look method. No comparison of validity was assessed.

Conclusion TNs assigning triage scores to ED patients on arrival, using only chief complaint and observation, were statistically comparable to scores assigned utilizing a resource-intense, comprehensive triage system, but clinically significant discrepancies were identified.

aDepartment of Emergency Medicine, Saskatoon Health Region, St Paul’s Hospital

bMedical School of College of Medicine

cClinical Research Support Unit, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Correspondence to Martin Betz, MD, Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Room C753, 2075 Bayview Avenue, Toronto, ON, Canada M6H 3M5 Fax: +1 416 480 4704; e-mail:

Received August 2, 2014

Accepted December 16, 2014

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