Agreement among pediatric health care professionals with the pediatric Canadian triage and acuity scale guidelines.
OBJECTIVE
To compare triage level assignment, using case scenarios, in a pediatric emergency department between registered nurses (RNs) and pediatric emergency physicians (PEPs) based on the Pediatric Canadian Triage and Acuity Scale (P-CTAS) guidelines. To compare triage level assignment of the RNs and PEPs to that done by a panel of experts using the same P-CTAS guidelines.


METHODS
A cross-sectional questionnaire survey (55 case scenarios) was sent to all RNs and PEPs working in the emergency department after the P-CTAS was implemented. Participants were instructed to assign a triage level for each case. A priori, all cases were assigned a triage level by a panel of experts using the P-CTAS guidelines. Kappa statistics and the mean number (+/-1SD) of correct responses were calculated.


RESULTS
A response rate of 85% was achieved (29 RNs, 15 PEPs). The kappa level of agreement (95% CI) among RNs was 0.51 (0.50-0.52) and was 0.39 (0.38-0.41) among PEPs (P < 0.001). The mean number of correct responses (+/-1SD) for RNs was 64% +/- 27% and for PEPs 60% +/- 22% (P = 0.31). Levels of agreement did not vary according to experience or type of shift work done or work status of RNs and PEPs.


CONCLUSIONS
With the introduction of the P-CTAS, the level of agreement and accuracy of triage categorization remained moderate for both RNs and PEPs. The reliability of the P-CTAS needs to be further assessed and the requirements for revisions considered prior to its widespread use.
Division of Emergency Medicine, Department of Paediatrics, Hôpital Ste-Justine, Université de Montréal, Montreal, Canada. liber@videotron.ca
Sylvie
S
Bergeron
Serge
S
Gouin
Benoit
B
Bailey
Devendra K
DK
Amre
Hema
H
Patel
D000208:Acute Disease; D000293:Adolescent; D001291:Attitude of Health Personnel; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009726:Nurses / Q000523:psychology*; D010372:Pediatrics; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014218:Triage