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Evaluation of the Validity and Reliability of ANKUTRIAGE, a New Decision Support System in Pediatric Emergency Triage
Aytaç Göktuğ1, Nisa Eda Çullas İlarslan2, Göksel Vatansever2
1From the Department of Pediatrics, Division of Pediatric Emergency Medicine, Sami Ulus Pediatrics Training and Research Hospital.
Insights
ANKUTRIAGE, a new pediatric triage system, showed high reliability and agreement with clinical outcomes and established triage methods. This computer-aided tool can standardize emergency care for children.
Area of Science:
- Pediatric Emergency Medicine
- Health Informatics
- Clinical Triage Systems
Background:
- Global increase in emergency service utilization necessitates effective pediatric triage.
- Current triage systems may lack standardization and efficiency in pediatric care.
- The ANKUTRIAGE system was developed to address these challenges.
Purpose of the Study:
- To evaluate the validity and reliability of the ANKUTRIAGE system in a pediatric emergency setting.
- To compare ANKUTRIAGE's performance against established triage scales.
- To assess the correlation between ANKUTRIAGE urgency levels and clinical outcomes.
Main Methods:
- Prospective, longitudinal study in a pediatric emergency department.
- Development and implementation of ANKUTRIAGE, a 5-level computer-aided triage decision support system.
- Validity assessed by comparing ANKUTRIAGE with Pediatric Canadian Triage and Acuity Scale (PCTAS) and Emergency Severity Index (ESI).
- Reliability assessed via interrater agreement using quadratic weighted kappa (κ).
Main Results:
- 1232 children (median age 4.00 years) included.
- ANKUTRIAGE acuity levels significantly correlated with resource use, life-saving procedures, PICU admission, and hospitalization rates (P < 0.001).
- High agreement with PCTAS (0.94) and moderate agreement with ESI (0.75).
- Excellent interrater reliability for ANKUTRIAGE (κ = 0.92).
Conclusions:
- ANKUTRIAGE demonstrates high validity, reliability, and agreement with clinical outcomes.
- The system offers a standardized and practical approach to pediatric triage.
- ANKUTRIAGE is particularly beneficial in busy emergency departments and for professionals with varying experience levels.
Background:
The intensity of emergency services is an increasing health problem all over the world, necessitating an effective triage system. The aim of this study was to evaluate the validity and reliability of the "ANKUTRIAGE" in children.
Methods:
This prospective, longitudinal study was carried out at a pediatric emergency department. ANKUTRIAGE, a 5-level computer-aided triage decision support system, was developed. Patients younger than 18 years who do not need emergency intervention, who had complete vital sign measurements, who gave consent for the study, and who were admitted to the emergency service during working hours with trained personnel were included. For validity, agreement between the urgency levels determined by ANKUTRIAGE and the reference triage systems: Pediatric Canadian Triage and Acuity Scale and Emergency Severity Index, was evaluated. In addition, the association of urgency levels with clinical outcomes was studied. To assess reliability, patients were evaluated by 2 blinded healthcare professionals using ANKUTRIAGE and a quadratic weighted κ was estimated.
Results:
A total of 1232 children with a median age of 4.00 years were included. ANKUTRIAGE acuity levels significantly correlated with the number of resources used, the number of patients undergoing life-saving procedures, pediatric intensive care unit, and overall hospitalization rates, respectively ( P < 0.001, P < 0.001, P < 0.001, P < 0.001). The agreement of ANKUTRIAGE with Pediatric Canadian Triage and Acuity Scale was found to be 0.94 (95% confidence interval [CI], 0.93-0.94), with an Emergency Severity Index of 0.75 (95% CI, 0.70-0.80). The interrater agreement between 2 evaluators who used ANKUTRIAGE reflected as excellent consistency 0.92 (95% CI, 0.89-0.95; κ > 0.8).
Conclusions:
ANKUTRIAGE demonstrated high agreement with clinical outcomes and with proven triage systems and reflected high reliability between users. ANKUTRIAGE will enable a more standardized and practical triage, especially in crowded pediatric emergency departments and in situations where triage is performed by health professionals with different experience and professions.
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