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

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

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. To assess the inter- and intra-rater reliability and ac...

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Bibliographic Details
Published in:South African medical journal Vol. 104; no. 5; pp. 372 - 375
Main Authors: Dalwai, Mohammed Khan, Twomey, Michele, Maikere, Jacob, Said, Shujaat, Wakeel, Muhammed, Jemmy, Jean-Paul, Valles, Pola, Tayler-Smith, Katie, Wallis, Lee, Zachariah, Rony
Format: Journal Article
Language:English
Published: South Africa Health & Medical Publishing Group 01-05-2014
Subjects:
Care and treatment
Critically ill
Cross-Sectional Studies
Emergency Nursing
Emergency service
Emergency Service, Hospital
Hospitals
Humans
Nursing
Observer Variation
Pakistan
Practice
Quality management
Reproducibility of Results
South Africa
Triage (Medicine)
Triage - statistics & numerical data
South Africa
Pakistan
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Summary: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. 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. 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. 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%). 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.
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ISSN:0256-9574
DOI:10.7196/SAMJ.7604