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Eur J Emerg Med. 2018 Aug;25(4):264-269. doi: 10.1097/MEJ.0000000000000449.

Reliability of the revised Swiss Emergency Triage Scale: a computer simulation study.

Author information

1
Department of Community, Primary Care and Emergency Medicine, Division of Emergency Medicine.
2
Department of Interdisciplinary Centers and Medical Logistics, Division of Emergency Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
3
Department of Medical Imaging and Information Sciences, School of Medicine, Division of Medical eHealth and Telemedicine, University Hospital, Geneva.
4
Department of Internal Medicine, Rehabilitation and Geriatrics, School of Medicine, Division of Medical Rehabilitation, Geneva University Hospital.

Abstract

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 κ 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 κ: 0.68; 95% confidence interval (CI): 0.60-0.78] and test-retest almost perfect agreement (mean κ: 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.

PMID:
28099182
PMCID:
PMC6039392
DOI:
10.1097/MEJ.0000000000000449
[Indexed for MEDLINE]
Free PMC Article

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