title: Reliability of the revised Swiss Emergency Triage Scale: a computer simulation study.
abstract: BACKGROUND
  The Swiss Emergency Triage Scale (SETS) is a four-level emergency scale that previously showed moderate reliability and high rates of undertriage due to a lack of standardization. It was revised to better standardize the measurement and interpretation of vital signs during the triage process.
  
  
  OBJECTIVE
  The aim of this study was to explore the inter-rater and test-retest reliability, and the rate of correct triage of the revised SETS.
  
  
  METHODS
  Thirty clinical scenarios were evaluated twice at a 3-month interval using an interactive computerized triage simulator by 58 triage nurses at an urban teaching emergency department admitting 60 000 patients a year. Inter-rater and test-retest reliabilities were determined using κ statistics. Triage decisions were compared with a gold standard attributed by an expert panel. Rates of correct triage, undertriage, and overtriage were computed. A logistic regression model was used to identify the predictors of correct triage.
  
  
  RESULTS
  A total of 3387 triage situations were analyzed. Inter-rater reliability showed substantial agreement [mean κ: 0.68; 95% confidence interval (CI): 0.60-0.78] and test-retest almost perfect agreement (mean κ: 0.86; 95% CI: 0.84-0.88). The rate of correct triage was 84.1%, and rates of undertriage and overtriage were 7.2 and 8.7%, respectively. Vital sign measurement was an independent predictor of correct triage (odds ratios for correct triage: 1.29 for each additional vital sign measured, 95% CI: 1.20-1.39).
  
  
  CONCLUSIONS
  The revised SETS incorporating standardized vital sign measurement and interpretation during the triage process resulted in high reliability and low rates of mistriage.
authors.affiliation: Department of Community, Primary Care and Emergency Medicine, Division of Emergency Medicine.
authors.forename: Olivier T
authors.initials: OT
authors.lastname: Rutschmann
authors.affiliation: Department of Interdisciplinary Centers and Medical Logistics, Division of Emergency Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Olivier W
authors.initials: OW
authors.lastname: Hugli
authors.affiliation: Department of Community, Primary Care and Emergency Medicine, Division of Emergency Medicine.
authors.forename: Christophe
authors.initials: C
authors.lastname: Marti
authors.affiliation: Department of Community, Primary Care and Emergency Medicine, Division of Emergency Medicine.
authors.forename: Olivier
authors.initials: O
authors.lastname: Grosgurin
authors.affiliation: Department of Medical Imaging and Information Sciences, School of Medicine, Division of Medical eHealth and Telemedicine, University Hospital, Geneva.
authors.forename: Antoine
authors.initials: A
authors.lastname: Geissbuhler
authors.affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, School of Medicine, Division of Medical Rehabilitation, Geneva University Hospital.
authors.forename: Michel
authors.initials: M
authors.lastname: Kossovsky
authors.affiliation: Department of Community, Primary Care and Emergency Medicine, Division of Emergency Medicine.
authors.forename: Josette
authors.initials: J
authors.lastname: Simon
authors.affiliation: Department of Community, Primary Care and Emergency Medicine, Division of Emergency Medicine.
authors.forename: François P
authors.initials: FP
authors.lastname: Sarasin
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D016638:Critical Illness / Q000628:therapy; D016529:Emergency Nursing / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D013557:Switzerland; D014218:Triage / Q000379:methods*; D055986:Vital Signs