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For some time, most emergency departments have been experiencing severe overcrowding which could lead to reductions in the quality of care. Consequently, nurse triage tools have been developed with the aim of getting 'the right patient to the right resources, at the right place and at the right time'. However, differences in emergency medical services in different countries have limited the generalisation of pre-existing triage systems; for this reason, specific algorithms corresponding to local characteristics are needed. Accordingly, we developed a specific French-language triage system called ELISA (Echelle Liegeoise d'Index de Sévérité à l'Admission - Liege admission severity scale). We aimed to test its validity in the present study.
The ELISA is a five-category (U1 to U5) nursing triage algorithm, using flow charts based on vital signs and anamnestic data. Each category is associated with a pre-established time delay for first medical contact. We tested inter-rater and intra-rater agreement respectively. As concerns inter-rater agreement, nine triage nurses sorted the same 100 patients. The assigned classifications compared the reference assignment and were analyzed with Cohen's kappa coefficient. Intra-rater agreement was tested by asking 30 triage nurses to sort the same 10 patients at two different times (T1 was early morning and T2 was late night). We compared the classification at T1 and T2 with the null hypothesis being no difference and determined whether differences were nurse dependent.
Statistical analysis of intra-rater agreement revealed that the mean difference between classification at T1 and T2 did not significantly depend on the nurse (P = 0.3487). This result allowed pooling of the data and testing to determine whether the mean was different from zero. We used the Sign test and found that classification at T1 was not different from classification at T2 (P = 0.581). As concerns inter-rater agreement, we used Cohen's kappa coefficient, which revealed an almost perfect agreement between classification by nurses and the reference.
The need for a specific triage tool in our emergency department led us to develop a new French-language triage scale. The present study demonstrates that this scale is a valid triage tool with very good inter-rater and intra-rater agreement. Such results now allow a future study to evaluate its efficiency.