Objective(s): Emergency Departments (ED) require a systematic approach to prioritize patient care depending on acuity. The Emergency Severity Index (ESI) scale is the most used. In France, the French Emergency Nurses’ Classification in Hospitals (FRENCH) is used. The aim of this study was to evaluate inter-rater reliability and validity of the ESI and FRENCH triage scales.
Methods: We performed a prospective monocentric study in a French University College Hospital over the 2016 summer. All patients admitted to ED were evaluated to the triage area by two pairs of emergency physicians, each unaware of the triage results of the other pair. Reliability was estimated by a quadratic weighted Kappa. Validity was evaluated by the association between the level of triage and the following indirect criteria: rate of admission, type of admission amount of resources and length of stay in the emergency ward.
Results: Both the ESI and FRENCH triage systems showed strong reliability (weighted Kappa respectively 0.85 and 0.87) without any significant difference. An association was established for both scales between the level of emergency and each of the indirect criteria of validity. The associations between triage level and the amount of resources and length of stay criteria were significantly stronger for ESI scale. The area under the Receiver Operating Characteristic curve for prediction of an admission was 0.75 for ESI and 0.71 for FRENCH scale without any significant difference.
Conclusion: ESI and FRENCH scales have a strong inter-rater reliability and appear to have a good validity. Other studies, particularly multicenter studies including more qualitative criteria, would probably make it possible to decide on the most effective triage method.
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