title: Assessment of inter-observer reliability of two five-level triage and acuity scales: a randomized controlled trial.
abstract: BACKGROUND
  The Emergency Severity Index (ESI) is an initial measure of patient assessment in the emergency department (ED). It rates patients based on acuity and predicted resource intensity from Level 1 (most ill) to Level 5 (least resource intensive). Already implemented and evaluated in several US hospitals, ESI has yet to be evaluated in a Canadian setting or compared with the five-level Canadian Emergency Department Triage and Acuity Scale (CTAS).
  
  
  OBJECTIVE
  To compare the inter-observer reliability of 2 five-level triage and acuity scales.
  
  
  METHODS
  Ten triage nurses, who had all been trained in the use of CTAS, from 4 urban, academic Canadian EDs were randomly assigned either to training in ESI version 3 (ESI v.3) or to refresher training in CTAS. They independently assigned triage scores to 200 emergency cases, unaware of the rating by the other nurses.
  
  
  RESULTS
  Number of years of nursing practice was the only significant demographic difference found between the 2 groups (p = 0.014). A quadratically weighted kappa to measure the inter-observer reliability of the CTAS group was 0.91 (0.90, 0.99) and not significantly different from that of the ESI group 0.89 (0.88, 0.99). An inter-test generalizability (G) study performed on the variance components derived from an analysis of variance (ANOVA) revealed G(5) = 0.90 (0.82, 0.99).
  
  
  CONCLUSIONS
  After 3 hours of training, experienced triage nurses were able to perform triage assessments using ESI v.3 with the same inter-observer reliability as those with experience and refresher training in using the CTAS.
authors: Department of Emergency Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada. aworster@rogers.com
authors: Andrew
authors: A
authors: Worster
authors: Nicki
authors: N
authors: Gilboy
authors: Christopher M
authors: CM
authors: Fernandes
authors: David
authors: D
authors: Eitel
authors: Kevin
authors: K
authors: Eva
authors: Rose
authors: R
authors: Geisler
authors: Paula
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authors: Tanabe