title: Inter-rater reliability and validity of the Ministry of Health of Turkey's mandatory emergency triage instrument.
abstract: OBJECTIVE
  In 2009, the Ministry of Health in Turkey mandated a three-level emergency triage scale coded with the colours red, yellow and green in descending order of acuity. This study was conducted to assess the reliability and validity of this mandatory emergency triage instrument in Turkey.
  
  
  METHODS
  This prospective study was conducted in the ED of an academic hospital with 40,000 presentations per year. The reliability assessment was between triage of a real life patient by an emergency medical technician vs the consensus of the investigators based on retrospective medical record review. The inter-rater agreement method with quadratic weighted kappa analysis was used. The instrument's validity was measured by ED length of stay, admission rates, in-hospital mortality, ED resource utilisation and lifesaving intervention.
  
  
  RESULTS
  A total of 618 patients were assigned to either red (n = 126), yellow (n = 352), or green (n = 140) by acuity level at triage. In this study, the triage scale demonstrated 'substantial' reliability with a quadratic weighted kappa value of 0.725 (95% CI 0.68-0.77). It also suggested validity regarding all the measured surrogate markers, as they were strongly associated with acuity level (P < 0.001 for each). Spearman's rank correlation coefficient between triage acuity and total number of used resources was 0.482 (95% CI 0.42-0.54).
  
  
  CONCLUSIONS
  This study demonstrates substantial reliability of Turkey's Ministry of Health's mandatory three-level triage instrument. Significant association was also observed between the triage levels and the validity parameters measured in the study.
authors.affiliation: Şanlıurfa Mehmet Akif Inan Training and Research Hospital, Şanlıurfa, Turkey.
authors.forename: M Emre
authors.initials: ME
authors.lastname: Erimşah
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Yaka
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Yilmaz
authors.affiliation: Kars State Hospital, Kars, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kama
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Pekdemir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D014218:Triage / Q000379:methods / Q000592:standards*; D014421:Turkey; D055815:Young Adult
keywords: emergency; inter-observer agreement; reliability; triage; validity