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Prehospital Application of the Canadian Triage and Acuity Scale by Emergency Medical Services.
CJEM. 2017 Jan; 19(1):26-31.CJEM

Abstract

OBJECTIVES

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+Show Affiliations

*Department of Emergency Medicine,University of Manitoba,Winnipeg,MB.*Department of Emergency Medicine,University of Manitoba,Winnipeg,MB.*Department of Emergency Medicine,University of Manitoba,Winnipeg,MB.*Department of Emergency Medicine,University of Manitoba,Winnipeg,MB.¶Department of Emergency Medicine,University of Alberta,Edmonton,AB.*Department of Emergency Medicine,University of Manitoba,Winnipeg,MB.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

27508353

Citation

Leeies, Murdoch, et al. "Prehospital Application of the Canadian Triage and Acuity Scale By Emergency Medical Services." CJEM, vol. 19, no. 1, 2017, pp. 26-31.
Leeies M, Ffrench C, Strome T, et al. Prehospital Application of the Canadian Triage and Acuity Scale by Emergency Medical Services. CJEM. 2017;19(1):26-31.
Leeies, M., Ffrench, C., Strome, T., Weldon, E., Bullard, M., & Grierson, R. (2017). Prehospital Application of the Canadian Triage and Acuity Scale by Emergency Medical Services. CJEM, 19(1), 26-31. https://doi.org/10.1017/cem.2016.345
Leeies M, et al. Prehospital Application of the Canadian Triage and Acuity Scale By Emergency Medical Services. CJEM. 2017;19(1):26-31. PubMed PMID: 27508353.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prehospital Application of the Canadian Triage and Acuity Scale by Emergency Medical Services. AU - Leeies,Murdoch, AU - Ffrench,Cheryl, AU - Strome,Trevor, AU - Weldon,Erin, AU - Bullard,Michael, AU - Grierson,Rob, Y1 - 2016/08/10/ PY - 2016/8/11/pubmed PY - 2017/10/13/medline PY - 2016/8/11/entrez KW - Canadian Triage Acuity Scale KW - Emergency Department Resource Utilization KW - Emergency Medical Services KW - Emergency Medicine KW - Paramedic KW - Prehospital Medicine KW - Triage KW - Triage Nurse SP - 26 EP - 31 JF - CJEM JO - CJEM VL - 19 IS - 1 N2 - OBJECTIVES: 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. SN - 1481-8035 UR - https://www.unboundmedicine.com/medline/citation/27508353/Prehospital_Application_of_the_Canadian_Triage_and_Acuity_Scale_by_Emergency_Medical_Services_ L2 - https://www.cambridge.org/core/product/identifier/S1481803516003456/type/journal_article DB - PRIME DP - Unbound Medicine ER -