Are Pediatric Triage Systems Reliable in the Emergency Department?

BACKGROUND: Few studies have focused on the agreement level of pediatric triage scales (PTSs). The aim of this meta-analytic review was to examine the level of inter-rater reliability of PTSs. METHODS: Detailed searches of a number of electronic databases were performed up to 1 March 2019. Studies that reported sample sizes, reliability coefficients, and a comprehensive description of the assessment of the inter-rater reliability of PTSs were included. The articles were selected according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) taxonomy. Two reviewers were involved in the study selection, quality assessment, and data extraction and performed the review process. The effect size was estimated by z-transformation of reliability coefficients. Data were pooled with random-effects models, and a metaregression analysis was performed based on the method of moments estimator. RESULTS: Thirteen studies were included. The pooled coefficient for the level of agreement was 0.727 (confidence interval (CI) 95%: 0.650-0.790). The level of agreement on PTSs was substantial, with a value of 0.25 (95% CI: 0.202-0.297) for the Australasian Triage Scale (ATS), 0.571 (95% CI: 0.372-0.720) for the Canadian Triage and Acuity Scale (CTAS), 0.810 (95% CI: 0.711-0.877) for the Emergency Severity Index (ESI), and 0.755 (95% CI: 0.522-0.883) for the Manchester Triage System (MTS). CONCLUSIONS: Overall, the reliability of pediatric triage systems was substantial, and this level of agreement should be considered acceptable for triage in the pediatric emergency department. Further studies on the level of agreement of pediatric triage systems are needed.

Recognizing Sudden Cardiac Arrest May Require More Than Two Questions during Telephone Triage: Developing a Complementary Checklist.

OBJECTIVE: To develop decision-support tools to identify patients experiencing sudden cardiac arrest (SCA). METHODS: Eighty calls related to SCA were content analyzed, and the contextual patterns that emerged were organized into a checklist. Two researchers independently analyzed the recorded calls and compared their findings. Eighteen dispatchers scored 20 cases (which included SCA and non-SCA cases) both with and without the checklist. Correct responses for each case and agreement among dispatchers have been reported. RESULTS: Eighty audio files (total time, 96 min) were analyzed, and a total of 602 codes were extracted from the text and recordings. The caller's tone of voice and presence or absence of background voices, calling for an ambulance and giving the dispatcher the address promptly, and description of the primary complaint and respirations accounted for 38%, 39%, and 23% of all codes, respectively. A 15-item complementary checklist has been developed. The mean percentages of correct responses were 66.9%+27.96% prior to the use of checklist and 80.05%+10.84% afterwards. Results of the independent t test for checklist scores showed that statistically significant differences were present between the SCA and non-SCA cases (t=5.88, df=18, p=0.000). CONCLUSION: Decision support tools can potentially increase the recognition rate of SCA cases, and therefore produce a higher rate of dispatcher-directed CPR.

The effect of Cincinnati Prehospital Stroke Scale on telephone triage of stroke patients: evidence-based practice in emergency medical services.

BACKGROUND: The emergency medical service is designed to recognize and transfer critically ill patients. Evidence-based practice has rarely been emphasized in the emergency medical service field, especially in the dispatch center. AIMS: To identify the effect of the Cincinnati Prehospital Stroke Scale (CPSS) on telephone triage of stroke patients by telephone triage nurses at the emergency medical dispatch center and to compare CPSS with the National Guidelines for Telephone Triage Tool (NGTT). METHODS: A quasi-empirical study was conducted from June 2013 to June 2014. The setting of the study was the Mashhad dispatch center of the EMS. Two hundred and forty-six patients were randomly allocated to the CPSS intervention group (n = 121) and the NGTT control group (n = 125). True triage, triage error and odds ratio were statistically reported. RESULTS: The mean age of the patients was 70.9 ±â€Š12.7 years. Of all the cases, 77.7 and 65.6% of patients in the intervention and the control groups, respectively, were accurately triaged. Under-triage cases were 10.7 and 13.6% of the patients in the intervention and the control groups. Odds ratio was 1.14 (95% confidence interval 0.62-2.07) for the CPSS compared with the NGTT. CONCLUSION: CPSS is more efficient for use by telephone triage nurses in identifying stroke. The use of CPSS assists nurses by reducing the triage error and supports the evidence-based care. It needs to be developed to cover signs and symptoms of posterior-circulation stroke patients.