Accuracy and interrater reliability of paediatric emergency department triage.
OBJECTIVE
To determine the accuracy and reliability of triage of children in public hospital EDs using the Australasian Triage Scale (ATS). This is the first study to examine these issues in paediatric triage following the 2007 development of the Emergency Triage Education Kit (ETEK) to foster accurate and consistent application of the ATS.


METHODS
A convenience sample of 167 triage nurses working at three general hospitals and one speciality paediatric hospital in greater metropolitan Melbourne assigned triage ratings for nine paediatric clinical scenarios using the ATS. Scenarios were derived from the ETEK or from other published sources. Kappa was used to assess interrater reliability within and between hospitals.


RESULTS
Triage nurses correctly assigned triage scores to an average of 5.3 of nine paediatric clinical scenarios. Accuracy in specific hospitals ranged from a low of 15% on one scenario, to 100% accuracy on a different scenario at a different hospital. Interrater reliability within and across the EDs studied was found to be kappa = 0.27. Both accuracy and interrater reliability were marginally higher at the speciality paediatric hospital.


CONCLUSIONS
Our findings demonstrate inconsistencies in the accuracy and reliability in which sick children presenting to EDs receive triage scores both within and across hospitals. These results suggest the need for improvements either in current triage nurse training or training resources. Use of the ETEK alone has not resulted in high levels of paediatric triage accuracy or reliability.
Health Systems and Workforce Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Amy R
AR
Allen
Health Systems and Workforce Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Matthew J
MJ
Spittal
Health Systems and Workforce Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Caroline
C
Nicolas
Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
Ed
E
Oakley
Health Systems and Workforce Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Gary L
GL
Freed
D002648:Child; D002675:Child, Preschool; D016529:Emergency Nursing / Q000592:standards / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015588:Observer Variation; D015203:Reproducibility of Results; D014218:Triage / Q000592:standards* / Q000706:statistics & numerical data
emergency department; hospital; nursing; paediatric; triage