Reliability and validity of a new five-level triage instrument
Reliability and validity of a new five-level triage instrument
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DOI：
10.1111/j.1553-2712.2000.tb01066.x
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发表时间：
2000-03-01
影响因子：
4.4
通讯作者：
Gilboy, N
中科院分区：
文献类型：
--
作者：
Wuerz, RC;Milne, LW;Gilboy, N
目的：分诊是医院急诊科（ED）的初始临床分类过程。由于三级分诊的重复性和有效性差，作者开发并验证了一种新的五级分诊工具，紧急情况严重程度指数（ESI）。研究目的为：1）针对艾德患者的临床资源和住院需求来验证分诊工具，以及2）测量工具的评价者间可靠性（再现性）。研究方法：这是一项前瞻性、观察性队列研究，以两个城市转诊医院100小时内分诊的成人患者为样本，以人群为基础。通过资源使用和住院（标准标准）进行验证，并通过盲法配对分诊分配与加权kappa分析进行重复性评估。结果：538例患者入组; 45例因评估不完整而被排除。结果493例患者中52%为女性，26%为非白人，中位年龄为40岁（范围16-95）;总体而言，159例（32%）患者住院。分诊分配的加权kappa为0.80（95% CI = 0.76 - 0.84）。资源使用和住院率与分诊水平密切相关。对于第5类患者，只有四分之一（17/67）需要任何诊断测试或程序，没有人住院（置信上限，5%）。相反，在第1类中，12名患者中有1名出院（置信上限为25%），并且没有一名患者需要少于两种资源。结论：在作者的实践环境中，这种五级分类工具被证明是有效和可靠的。它可重复地将患者分为五个不同的层次，从非常高的住院/资源强度到非常低的住院/资源强度。
Objectives: Triage is the initial clinical sorting process in hospital emergency departments (EDs). Because of poor reproducibility and validity of three-level triage, the authors developed and validated a new five-level triage instrument, the Emergency Severity Index (ESI). The study objectives were: 1) to validate the triage instrument against ED patients' clinical resource and hospitalization needs, and 2) to measure the interrater reliability (reproducibility) of the instrument. Methods: This was a prospective, observational cohort study of a population-based convenience sample of adult patients triaged during 100 hours at two urban referral hospitals. Validation by resource use and hospitalization (criterion standards) and reproducibility by blinded paired triage assignments compared with weighted kappa analysis were assessed. Results: Five hundred thirty-eight patients were enrolled; 45 were excluded due to incomplete evaluations. The resulting cohort of 493 patients was 52% female, was 26% nonwhite, and had a median age of 40 years (range 16-95); overall, 159 (32%) patients were hospitalized. Weighted kappa for triage assignment was 0.80 (95% Cl = 0.76 to 0.84). Resource use and hospitalization rates were strongly associated with triage level. For patients in category 5, only one-fourth (17/67) required any diagnostic test or procedure, and none were hospitalized (upper confidence limit, 5%). Conversely, in category 1, one of twelve patients was discharged (upper confidence limit, 25%), and none required fewer than two resources. Conclusions: This five-level triage instrument was shown to be both Valid and reliable in the authors' practice settings. It reproducibly triages patients into five distinct strata, from very high hospitalization/resource intensity to very low hospitalization/resource intensity.