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Reliability of the revised Swiss Emergency Triage Scale: a computer simulation study.
Olivier T Rutschmann1, Olivier W Hugli2, Christophe Marti1
1Department of Community, Primary Care and Emergency Medicine, Division of Emergency Medicine.
Summary
The revised Swiss Emergency Triage Scale (SETS) demonstrates high reliability and accuracy in emergency department triage. Standardized vital sign measurement significantly improves correct triage rates, reducing mistriage.
Area of Science:
- Emergency Medicine
- Healthcare Quality Improvement
- Clinical Triage
Background:
- The Swiss Emergency Triage Scale (SETS) previously had moderate reliability and high undertriage rates due to inconsistent standardization.
- A revised SETS was developed to standardize vital sign measurement and interpretation during triage.
Purpose of the Study:
- To evaluate the inter-rater and test-retest reliability of the revised SETS.
- To assess the accuracy of triage decisions made using the revised SETS.
- To identify predictors of correct triage with the revised SETS.
Main Methods:
- 58 triage nurses evaluated 30 clinical scenarios twice using a computerized simulator over 3 months.
- Inter-rater and test-retest reliability were assessed using kappa statistics.
- Triage accuracy was compared to an expert panel's gold standard.
Main Results:
- Substantial inter-rater agreement (κ=0.68) and almost perfect test-retest agreement (κ=0.86) were observed.
- The correct triage rate was 84.1%, with undertriage at 7.2% and overtriage at 8.7%.
- Measuring more vital signs independently predicted correct triage (OR=1.29).
Conclusions:
- The revised SETS, with standardized vital sign protocols, shows high reliability.
- This revised scale significantly reduces mistriage rates in emergency departments.
- Standardized vital sign assessment is crucial for accurate emergency triage.
