Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan

Hdl Handle:
http://hdl.handle.net/10144/322385
Title:
Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan
Authors:
Dalwai, M K; Twomey, M; Maikere, J; Said, S; Wakeel, M; Jemmy, J-P; Valles, P; Tayler-Smith, K; Wallis, L; Zachariah, R
Journal:
South African Medical Journal
Abstract:
Background. Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low- and middle-income countries this strategy is underused, under-resourced and poorly researched. Objective. To assess the inter- and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan. Methods. Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard. Results. Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 - 0.85). The intra-rater agreement was also high with 87% exact agreement (95% CI 67 - 100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of over-triage did not exceed the acceptable threshold of 30 - 50%. Under-triage was acceptable for all except emergency cases (66%). Conclusion. ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for ‘very urgent’ and ‘routine’ cases, importantly, it may under-triage ‘emergency’ cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed.
Publisher:
Health & Medical Publishing Group
Issue Date:
Mar-2014
URI:
http://hdl.handle.net/10144/322385
DOI:
10.7196/samj.7604
Additional Links:
http://www.samj.org.za/index.php/samj/article/view/7604
Language:
en
ISSN:
2078-5135; 0256-9574
Appears in Collections:
Emergencies/refugees

Full metadata record

DC FieldValue Language
dc.contributor.authorDalwai, M Ken_GB
dc.contributor.authorTwomey, Men_GB
dc.contributor.authorMaikere, Jen_GB
dc.contributor.authorSaid, Sen_GB
dc.contributor.authorWakeel, Men_GB
dc.contributor.authorJemmy, J-Pen_GB
dc.contributor.authorValles, Pen_GB
dc.contributor.authorTayler-Smith, Ken_GB
dc.contributor.authorWallis, Len_GB
dc.contributor.authorZachariah, Ren_GB
dc.date.accessioned2014-07-03T22:17:08Z-
dc.date.available2014-07-03T22:17:08Z-
dc.date.issued2014-03-
dc.identifier.citationReliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan 2014, 104 (5):372 South African Medical Journalen_GB
dc.identifier.issn2078-5135-
dc.identifier.issn0256-9574-
dc.identifier.doi10.7196/samj.7604-
dc.identifier.urihttp://hdl.handle.net/10144/322385-
dc.description.abstractBackground. Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low- and middle-income countries this strategy is underused, under-resourced and poorly researched. Objective. To assess the inter- and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan. Methods. Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard. Results. Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 - 0.85). The intra-rater agreement was also high with 87% exact agreement (95% CI 67 - 100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of over-triage did not exceed the acceptable threshold of 30 - 50%. Under-triage was acceptable for all except emergency cases (66%). Conclusion. ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for ‘very urgent’ and ‘routine’ cases, importantly, it may under-triage ‘emergency’ cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed.en_GB
dc.language.isoenen
dc.publisherHealth & Medical Publishing Groupen_GB
dc.relation.urlhttp://www.samj.org.za/index.php/samj/article/view/7604en_GB
dc.rightsPublished by: Health and Medical Publishing Group Archived on this site with kind permission of the Health and Medical Publishing Group and the South African Medical Association, [url]http://www.samj.org.za[/url]en_GB
dc.subjectOtheren_GB
dc.titleReliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistanen
dc.identifier.journalSouth African Medical Journalen_GB
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