Abstract
Background Few studies have focused on the agreement level of pediatric triage scales (PTSs). The aim of this meta-analytic review was to examine the level of inter-rater reliability of PTSs. Methods Detailed searches of a number of electronic databases were performed up to 1 March 2019. Studies that reported sample sizes, reliability coefficients, and a comprehensive description of the assessment of the inter-rater reliability of PTSs were included. The articles were selected according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) taxonomy. Two reviewers were involved in the study selection, quality assessment, and data extraction and performed the review process. The effect size was estimated by z-transformation of reliability coefficients. Data were pooled with random-effects models, and a metaregression analysis was performed based on the method of moments estimator. Results Thirteen studies were included. The pooled coefficient for the level of agreement was 0.727 (confidence interval (CI) 95%: 0.650–0.790). The level of agreement on PTSs was substantial, with a value of 0.25 (95% CI: 0.202–0.297) for the Australasian Triage Scale (ATS), 0.571 (95% CI: 0.372–0.720) for the Canadian Triage and Acuity Scale (CTAS), 0.810 (95% CI: 0.711–0.877) for the Emergency Severity Index (ESI), and 0.755 (95% CI: 0.522–0.883) for the Manchester Triage System (MTS). Conclusions Overall, the reliability of pediatric triage systems was substantial, and this level of agreement should be considered acceptable for triage in the pediatric emergency department. Further studies on the level of agreement of pediatric triage systems are needed.
Highlights
Children increasingly visit emergency departments (ED) in the recent years [1]
Pediatric triage scales (PTSs) are used to prioritize children to receive care in the EDs [4]. ey are essential to ensuring safety of patients and protection against undertriage [5]
Subgroups were organized for triage scales (ATS, Canadian Triage and Acuity Scale (CTAS), Emergency Severity Index (ESI), and Manchester Triage System (MTS)), raters, and reliability statistics. e level of agreement among the reviewers in the final selection of the articles was almost perfect (κ 1.0). e total sample size from all studies was 29,094. e studies were conducted in five countries (Australia, Canada, Iran, Netherlands, and the USA) (Table 2). e publication year of the studies ranged from 2002 to 2015
Summary
Children increasingly visit emergency departments (ED) in the recent years [1]. Infections of the upper respiratory tract, asthma, and nonbacterial gastroenteritis were the most common diagnoses among frequent utilizers of the EDs [2]. E increased number of children presenting to the EDs raises the importance of triaging them to the most appropriate level of care [3]. It becomes more of a priority due to the overcrowding of pediatric patients. Inter-rater reliability is the most common method of reliability assessment in the triage room [7]. It represents the extent of agreement among clinicians. Few studies have focused on the agreement level of pediatric triage scales (PTSs). Further studies on the level of agreement of pediatric triage systems are needed
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