Interrater Agreement between Nurses for the Pediatric Canadian Triage and Acuity Scale in a Tertiary Care Center
Interrater Agreement between Nurses for the Pediatric Canadian Triage and Acuity Scale in a Tertiary Care Center
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DOI：
10.1111/j.1553-2712.2008.00268.x
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发表时间：
2008-12-01
影响因子：
4.4
通讯作者：
Amre, Devendra
中科院分区：
文献类型：
--
作者：
Gravel, Jocelyn;Gouin, Serge;Amre, Devendra
目的是测量护士之间的协议分配分诊级别的儿童访问儿科急诊科（ED）的辅助下，由一个计算机化版本的加拿大儿科分诊和敏锐度量表（PedCTAS）。这是一个前瞻性队列研究，评估儿童分诊从2级（紧急）到5级（非紧急）。从2007年4月至9月，在三级护理儿科艾德的38个班次中，对一个方便的患者样本进行了分类评价。所有患者最初均由常规分诊护士使用PedCTAS的计算机化版本进行分诊。研究护士使用相同的分诊工具进行第二次评估，对第一次评估不知情。这些研究护士是专门为研究目的加班的常规艾德护士。主要结果测量是两名护士之间的评价者间一致性，通过线性加权Kappa评分测量。次要结果包括护士没有应用Staturg建议的分诊水平的患者比例（覆盖）和对这些覆盖的同意。总体评价者间一致性为中度（线性加权kappa评分为0.55 [95%置信区间{CI} = 0.48 - 0.61]，二次加权kappa评分为0.61 [95% CI = 0.42 - 0.80]）。仅10例患者（研究人群的2%）存在一个以上节段的差异。分别有23.2%和21.8%的常规和研究分诊护士被覆盖。这些覆盖平均分布在增加和减少分诊level.Nurses使用Staturg，这是一个计算机化版本的PedCTAS，表现出中度评分员间协议分配分诊水平的儿童提出了儿科ED。
The objective was to measure the interrater agreement between nurses assigning triage levels to children visiting a pediatric emergency departments (EDs) assisted by a computerized version of the Pediatric Canadian Triage and Acuity Scale (PedCTAS).This was a prospective cohort study evaluating children triaged from Level 2 (emergent) to Level 5 (nonurgent). A convenience sample of patients triaged during 38 shifts from April to September 2007 in a tertiary care pediatric ED was evaluated. All patients were initially triaged by regular triage nurses using a computerized version of the PedCTAS. Research nurses performed a second evaluation blinded to the first evaluation using the same triage tool. These research nurses were regular ED nurses performing extra hours for research purposes exclusively. The primary outcome measure was the interrater agreement between the two nurses as measured by the linear weighted kappa score. Secondary outcomes included the proportion of patient for which nurses did not apply the triage level suggested by Staturg (override) and agreement for these overrides.A total of 499 patients were recruited. The overall interrater agreement was moderate (linear weighted kappa score of 0.55 [95% confidence interval {CI} = 0.48 to 0.61] and quadratic weighted kappa score of 0.61 [95% CI = 0.42 to 0.80]). There was a discrepancy of more than one level in only 10 patients (2% of the study population). Overrides occurred in 23.2 and 21.8% for regular and research triage nurses, respectively. These overrides were equally distributed between increase and decrease in triage level.Nurses using Staturg, which is a computerized version of the PedCTAS, demonstrated moderate interrater agreement for assignment of triage level to children presenting to a pediatric ED.