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Validation of the short form of the International Crowding Measure in Emergency Departments

an international study

Boyle, Adriana; Atkinson, Pauld; Basaure Verdejo, Carlosg; Chan, Edwardf; Clouston, Robind; Gilligan, Paedarh; Grewal, Karanf; Higginson, Ianc; Liston, Pauli; Newcombe, Virginiab; Norton, Valeriej; Richter, Sophiea; Stoica, Georgee; Wakai, Abelh

European Journal of Emergency Medicine: December 2019 - Volume 26 - Issue 6 - p 405–411
doi: 10.1097/MEJ.0000000000000579
Original Articles

Objective There is little consensus on the best way to measure emergency department (ED) crowding. We have previously developed a consensus-based measure, the International Crowding Measure in Emergency Departments. We aimed to externally validate a short form of the International Crowding Measure in Emergency Department (sICMED) against emergency physician’s perceptions of crowding and danger.

Methods We performed an observational validation study in seven EDs in five different countries. We recorded sICMED observations and the most senior available emergency physician’s perceptions of crowding and danger at the same time. We performed a times series regression model.

Results A total of 397 measurements were analysed. The sICMED showed moderate positive correlations with emergency physician’s perceptions of crowding, r = 0.4110, P < 0.05) and safety (r = 0.4566, P < 0.05). There was considerable variation in the performance of the sICMED between different EDs. The sICMED was only slightly better than measuring occupancy or ED boarding time.

Conclusion The sICMED has moderate face validity at predicting clinician’s concerns about crowding and safety, but the strength of this validity varies between different EDs and different countries.

aAddenbrookes Hospital

bCambridge University, Cambridge

cDerriford Hospital, Plymouth, UK

dSaint John Regional Hospital

eHorizon Health Network Saint John, Saint John, New Brunswick

fSouthlake Regional Health Centre, Newmarket, Ontario, Canada

gHospital Clínico Pontificia Universidad Católica de Chile, Santiago, Chile

hBeaumont Hospital

iDublin City University, Dublin, Ireland

jScripps Mercy Hospital, San Diego, California, USA

Received 24 March 2018 Accepted 8 August 2018

Correspondence to Adrian Boyle, MD, FCEM, Addenbrookes Hospital, Cambridge University, Cambridge CB2 2QQ, UK, Tel: + 44 122 324 5151; e-mail:

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