title: Prehospital Application of the Canadian Triage and Acuity Scale by Emergency Medical Services.
abstract: OBJECTIVE
  Triage is fundamental to emergency patient assessment. Effective triage systems accurately prioritize patients and help predict resource utilization. CTAS is a validated five-level triage score utilized in Emergency Departments (EDs) across Canada and internationally. Historically CTAS has been applied by triage nurses in EDs. Observational evidence suggests that the CTAS might be implemented reliably by paramedics in the prehospital setting. This is the first system-wide assessment of CTAS interrater reliability between paramedics and triage nurses during clinical practice.
  
  
  METHODS
  Variables were extracted from hospital and EMS databases. EMS providers determined CTAS on-scene, CTAS pre-transport, and CTAS on-arrival at hospital for each patient (N=14,378). The hospital arrival EMS CTAS (CTAS arrival ) score was compared to the initial nursing CTAS score (CTAS initial ) and the final nursing CTAS score (CTAS final ) incuding nursing overrides. Interrater reliability between ED CTAS initial and EMS CTAS arrival scores was assessed. Interrater reliability between ED CTAS final and EMS CTAS arrival scores, as well as proportion of patient encounters with perfect or near-perfect agreement, were evaluated.
  
  
  RESULTS
  Our primary outcome, interrater reliability [kappa=0.437 (p<0.001, 95% CI 0.421-0.452)], indicated moderate agreement. EMS CTAS arrival and ED CTAS initial scores had an exact or within one point match 84.3% of the time. The secondary interrater reliability outcome between hospital arrival EMS CTAS (CTAS arrival ) score and the final ED triage CTAS score (CTAS final ) showed moderate agreement with kappa =0.452 (p<0.001, 95% CI 0.437-0.466).
  
  
  CONCLUSIONS
  Interrater reliability of CTAS scoring between triage nurses and paramedics was moderate in this system-wide implementation study.
authors: *Department of Emergency Medicine,University of Manitoba,Winnipeg,MB.
authors: Murdoch
authors: M
authors: Leeies
authors: *Department of Emergency Medicine,University of Manitoba,Winnipeg,MB.
authors: Cheryl
authors: C
authors: Ffrench
authors: *Department of Emergency Medicine,University of Manitoba,Winnipeg,MB.
authors: Trevor
authors: T
authors: Strome
authors: *Department of Emergency Medicine,University of Manitoba,Winnipeg,MB.
authors: Erin
authors: E
authors: Weldon
authors: ¶Department of Emergency Medicine,University of Alberta,Edmonton,AB.
authors: Michael
authors: M
authors: Bullard
authors: *Department of Emergency Medicine,University of Manitoba,Winnipeg,MB.
authors: Rob
authors: R
authors: Grierson
mesh_terms: D002170:Canada; D016009:Chi-Square Distribution; D002983:Clinical Competence; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004632:Emergency Medical Services / Q000458:organization & administration*; D016529:Emergency Nursing / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014218:Triage / Q000379:methods*
keywords: Canadian Triage Acuity Scale; Emergency Department Resource Utilization; Emergency Medical Services; Emergency Medicine; Paramedic; Prehospital Medicine; Triage; Triage Nurse