The Canadian Triage and Acuity Scale for children: a prospective multicenter evaluation.
OBJECTIVE
The aims of the study are to measure both the interrater agreement of nurses using the Canadian Triage and Acuity Scale in children and the validity of the scale as measured by the correlation between triage level and proxy markers of severity.


METHODS
This was a prospective multicenter study of the reliability and construct validity of the Canadian Triage and Acuity Scale in 9 tertiary care pediatric emergency departments (EDs) across Canada during 2009 to 2010. Participants were a sample of children initially triaged as Canadian Triage and Acuity Scale level 2 (emergency) to level 5 (nonurgent). Participants were recruited immediately after their initial triage to undergo a second triage assessment by the research nurse. Both triages were performed blinded to the other. The primary outcome measures were the interrater agreement between the 2 nurses and the association between triage level and hospitalization. Secondary outcome measures were the association between triage level and health resource use and length of stay in the ED.


RESULTS
A total of 1,564 patients were approached and 1,464 consented. The overall interrater agreement was good, as demonstrated by a quadratic weighted κ score of 0.74 (95% confidence interval 0.71 to 0.76). Hospitalization proportions were 30%, 8.3%, 2.3%, and 2.2% for patients triaged at levels 2, 3, 4, and 5, respectively. There was also a strong association between triage levels and use of health care resources and length of stay.


CONCLUSIONS
The Canadian Triage and Acuity Scale demonstrates a good interrater agreement between nurses across multiple pediatric EDs and is a valid triage tool, as demonstrated by its good association with markers of severity.
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada. graveljocelyn@hotmail.com
Jocelyn
J
Gravel
Serge
S
Gouin
Ran D
RD
Goldman
Martin H
MH
Osmond
Eleanor
E
Fitzpatrick
Kathy
K
Boutis
Chantal
C
Guimont
Gary
G
Joubert
Kelly
K
Millar
Sarah
S
Curtis
Douglas
D
Sinclair
Devendra
D
Amre
D000293:Adolescent; D002170:Canada; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D009726:Nurses; D015588:Observer Variation; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D016037:Single-Blind Method; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods*