title: Reliability and validity of a new French-language triage algorithm: the ELISA scale.
abstract: OBJECTIVE
  Overcrowding in emergency departments (ED) leads to reductions in quality of care. Consequently, several different triage tools have been developed to prioritise patient intake. Differences in emergency medical services in different countries have limited the generalisation of pre-existing triage systems; for this reason, specific algorithms corresponding to local characteristics are needed. Accordingly, we developed a specific French-language triage system named Echelle Liégeoise d'Index de Sévérité à l'Admission (ELISA). This study tested its validity and efficiency.
  
  
  METHODS
  ELISA is a five-category nursing triage algorithm. Intrarater agreement was tested by comparing triage levels attributed to the same clinical scenarios at two different times. Interrater agreement was investigated by comparing triage categories attributed to clinical cases by different triage nurses. Finally, validity was estimated by studying the correlations between the triage ranking assigned by the nurse and actual resource consumption and patient outcome.
  
  
  RESULTS
  The distribution of the difference between nurse classification at the two times was statistically unrelated to which nurse carried out the evaluation. Regarding interrater agreement, assigned classifications were compared to the reference assignment. Cohen's κ coefficient revealed an almost perfect agreement between classification by nurses and the reference. Finally, statistical analysis revealed a strong relation between ELISA and the overall need for supplementary clinical testing. Outcomes were also significantly correlated with ELISA.
  
  
  CONCLUSIONS
  The need for a specific, French-language triage tool in our ED led us to develop a new triage scale. This study demonstrates that the scale is a valid triage tool with high interrater and intrarater agreement and considerable efficiency.
authors.affiliation: Emergency Department, University Hospital of Liege, , Liège, Belgium.
authors.forename: Jerôme
authors.initials: J
authors.lastname: Jobé
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ghuysen
authors.forename: Paul
authors.initials: P
authors.lastname: Gérard
authors.forename: Gary
authors.initials: G
authors.lastname: Hartstein
authors.forename: Vincent
authors.initials: V
authors.lastname: D'Orio
mesh_terms: D000328:Adult; D000465:Algorithms; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D015588:Observer Variation; D015203:Reproducibility of Results; D014218:Triage / Q000458:organization & administration* / Q000592:standards
keywords: triage