J Korean Soc Emerg Med.  2019 Aug;30(4):309-317. 10.0000/jksem.2019.30.4.309.

Inter-rater agreement of Korean Triage and Acuity Scale between emergency physicians and nurses

Affiliations
  • 1Department of Emergency Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea. iqtus@hanmai.net

Abstract


OBJECTIVE
The Korean Triage and Acuity Scale (KTAS) has been used in all emergency departments (EDs) since 2016. Medical personnel can provide the treatment priority based on the KTAS levels. The inter-rater agreement with KTAS has not been reported, even though most triage assignments are performed by nurses in Korea. This study was aimed to verify the agreement of triage levels between emergency physicians (EPs) and nurses with KTAS.
METHODS
This was a prospective, single-center study of an academic tertiary medical center. If the patient visits the ED, the triage nurse and EP meet the patients together. The nurse performed the history taking and physical examinations including vital signs measurements then recorded the KTAS levels. The EP did not interfere with the nurse's decision. The EP also decided the KTAS levels. The designated codes and levels were compared. The EP recorded the detailed reasons for the disagreement if there was discrepancy.
RESULTS
Comparisons were performed with 928 patients. The number of patients in each KTAS level was 95 (10.2%) in level I, 263 (28.3%) in level II, 348 (37.5%) in level III, 144 (15.5%) in level IV, and 78 (8.4%) in level V. The overall agreement was 761 (82%), and the Kappa coefficient was 0.691. The errors of history taking were most frequent (131, 78.4%). Insufficient understanding of the disease pathophysiology, inaccurate neurological examinations, and errors that did not consider the vital signs except for the blood pressure were encountered in 12 (7.2%).
CONCLUSION
The agreement rate was high between EPs and nurses using KTAS (K=0.691, substantial agreement).

Keyword

Triage; Interobserver; Observer variations

MeSH Terms

Blood Pressure
Emergencies*
Emergency Service, Hospital
Humans
Korea
Neurologic Examination
Observer Variation
Physical Examination
Prospective Studies
Triage*
Vital Signs
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