title: Inter-rater reliability between nurses for a new paediatric triage system based primarily on vital parameters: the Paediatric Triage Instrument (PETI).
abstract: The major paediatric triage systems are primarily based on flow charts involving signs and symptoms for orientation and subjective estimates of the patient's condition. In contrast, the 4-level Paediatric Triage Instrument (PETI) is primarily based on vital parameters and was developed exclusively for paediatric triage in patients with medical symptoms. The aim of this study was to assess the inter-rater reliability of this triage system in children when used by nurses.
  
  
  
  A design was employed in which triage was performed simultaneously and independently by a research nurse and an emergency department (ED) nurse using the PETI. All patients aged ≤12 years who presented at the ED with a medical symptom were considered eligible for participation.
  
  
  
  The 89 participants exhibited a median age of 2 years and were triaged by 28 different nurses. The inter-rater reliability between nurses calculated with the quadratic-weighted κ was 0.78 (95% CI 0.67 to 0.89); the linear-weighted κ was 0.67 (95% CI 0.56 to 0.80) and the unweighted κ was 0.59 (95% CI 0.44 to 0.73). For the patients aged <1, 1-3 and >3 years, the quadratic-weighted κ values were 0.67 (95% CI 0.39 to 0.94), 0.86 (95% CI 0.75 to 0.97) and 0.73 (95% CI 0.49 to 0.97), respectively. The median triage duration was 6 min.
  
  
  
  The PETI exhibited substantial reliability when used in children aged ≤12 years and almost perfect reliability among children aged 1-3 years. Moreover, rapid application of the PETI was demonstrated. This study has some limitations, including sample size and generalisability, but the PETI exhibited promise regarding reliability, and the next step could be either a larger reliability study or a validation study.
authors.affiliation: Department of Paediatrics, Mälarsjukhuset Hospital, Eskilstuna, Sweden.|Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
authors.forename: Jaana
authors.initials: J
authors.lastname: Karjala
authors.affiliation: Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.|Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.|Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Eriksson
mesh_terms: D002648:Child; D002675:Child, Preschool; D004506:Education, Nursing; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009726:Nurses; D015588:Observer Variation; D010372:Pediatrics / Q000379:methods; D015203:Reproducibility of Results; D013548:Sweden; D014218:Triage / Q000379:methods*
keywords: ACCIDENT & EMERGENCY MEDICINE; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; PAEDIATRICS