title: Validation of an emergency triage scale for obstetrics and gynaecology: a prospective study.
abstract: OBJECTIVE
  To evaluate the reliability of a four-level triage scale for obstetrics and gynaecology emergencies and to explore the factors associated with an optimal triage.
  
  
  METHODS
  Thirty clinical vignettes presenting the most frequent indications for obstetrics and gynaecology emergency consultations were evaluated twice using a computerised simulator.
  
  
  METHODS
  The study was performed at the emergency unit of obstetrics and gynaecology at the Geneva University Hospitals.
  
  
  METHODS
  The vignettes were submitted to nurses and midwives.
  
  
  METHODS
  We assessed inter- and intra-rater reliability and agreement using a two-way mixed-effects intra-class correlation (ICC). We also performed a generalised linear mixed model to evaluate factors associated triage correctness.
  
  
  METHODS
  Triage acuity.
  
  
  RESULTS
  We obtained a total of 1191 evaluations. Inter-rater reliability was good (ICC 0.748; 95% CI 0.633-0.858) and intra-rater reliability was almost perfect (ICC 0.812; 95% CI 0.726-0.889). We observed a wide variability: the mean number of questions varied from 6.9 to 18.9 across individuals and from 8.4 to 16.9 across vignettes. Triage acuity was underestimated in 12.4% of cases and overestimated in 9.3%. Undertriage occurred less frequently for gynaecology compared with obstetric vignettes [odds ratio (OR) 0.45; 95% CI 0.23-0.91; P = 0.035] and decreased with the number of questions asked (OR 0.94; 95% CI 0.88-0.99; P = 0.047). Certification in obstetrics and gynaecology emergencies was an independent factor for the avoidance of undertriage (OR 0.35; 95% CI 0.17-0.70; P = 0.003).
  
  
  CONCLUSIONS
  The four-level triage scale is a valid and reliable tool for the integrated emergency management of obstetrics and gynaecology patients.
  
  
  CONCLUSIONS
  The Swiss Emergency Triage Scale is a valid and reliable tool for obstetrics and gynaecology emergency triage.
authors.affiliation: Department of Gynaecology and Obstetrics, Lausanne University Hospital and Faculty of Medicine, Lausanne, Switzerland.|Faculty of Medicine, University of Geneva, Geneva, Switzerland.|Department of Obstetrics and Gynaecology, Medical University Vienna, Vienna, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Veit-Rubin
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland.|Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Brossard
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland.|CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Gayet-Ageron
authors.affiliation: Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Montandon
authors.affiliation: Nursing Department, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Simon
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland.|Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Irion
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland.|Department of Primary Care, Community and Emergency Medicine, Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: O T
authors.initials: OT
authors.lastname: Rutschmann
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland.|Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Martinez de Tejada
mesh_terms: D000328:Adult; D003198:Computer Simulation; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000379:methods* / Q000592:standards; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D008880:Midwifery / Q000379:methods / Q000592:standards; D015588:Observer Variation; D009774:Obstetrics / Q000379:methods* / Q000592:standards; D062072:Patient Acuity; D011247:Pregnancy; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D014218:Triage / Q000379:methods* / Q000592:standards
keywords: Reliability; triage; validity