Reliability of a Comprehensive Fivelevel Triage System: Modified Canadian Triage and Acuity Scale

Jang, Jun Ho; Oh, Bum Jin; Lee, Jae Ho; Kim, Won; Lim, Kyoung Soo

Abstract

PURPOSE: Congestion at emergency department (ED) entrances is a common problem that makes it difficult to assign patients proper priority for treatment based on the severity of their condition. A comprehensive five-scale triage system has widely been accepted over other scaling systems as the most effective triage tool in ED. Our aim was to evaluate the reliability and usefulness of the modified Canadian Triage and Acuity Scale (mCTAS) as a comprehensive five-scale triage system.
METHODS
Two hundred ninety-eight ED patients were recruited in the triage room of one university hospital between December 7 and December 24, 2004. A modified mCTAS was tested for inter-rater reliability by emergency physicians and clinical nurse specialists (CNSs). mCTAS and the Modified Asan Triage Score (MATS) were calculated by doctors and nurses independently. Clinical values measured were discharge decisions, admission to general ward or intensive care unit, and time to clinical decisions. SAS and SPSS 10.0 for Windows were used for statistical analysis.
RESULTS
The weighted kappa statistics were 0.65 among the CNSs (95% CI = 0.47-0.84) and 0.67 for emergency physicians (95% CI = 0.58-0.77). respectively. As evaluated by mCTAS, The ICU admission rate was higher for level 1 cases (40.00%) and level 2 cases (27.5%) than for other levels (p < 0.01). mCTAS and MATS scores indicated that more severe cases had a higher rate of admission to the ICU and the less severity cases showed a higher rate of discharge from the ED. In addition, t-value and F value scores revealed that the sensitivity of mCTAS (t = - 6.30, F = - 39.63) was greater than that of MATS (t = -5.48, F = 30.02).
CONCLUSION
mCTAS showed good inter-rater reliability and usefulness as a triage tool and was more reliable than MAST in indicating the severity of condition of ED patients.