The soterion rapid triage system: Evaluation of interrater reliability and validity

Abstract

Study objectives: Triage is a critical function for the timely delivery of emergency health care and the appropriate allocation of emergency department (ED) resources. The Soterion Rapid Triage System is a new, computerized, chief complaint–based, algorithm-driven, 5-level triage acuity system. We describe our experience using the system through our evaluation of the system's interrater reliability and validity as a tool for stratification of patient acuity. Methods: The study was conducted in a 389-bed Level II trauma center that experiences approximately 57,000 ED patient visits per year. The study was composed of 2 components. A prospective evaluation of the interrater reliability of the system was conducted by the blinded, paired simultaneous triage of 423 patients. A retrospective evaluation of validity consisted of the analysis of 33,850 patients triaged with the system during an 8-month period. The system's validity was measured by inhospital admission rate, ED length of stay, and resource consumption. Resource consumption was measured by total hospital, laboratory, radiology, and pharmacy charges and current procedural terminology (CPT) codes 99821 to 99825. Results: Interrater reliability, determined by the weighted κ statistical method for ranked data, was 0.87 (95% confidence in terval 0.84 to 0.91). In the retrospective analysis, inhospital admission rates and hospital charges decreased as triage acuity decreased. The inhospital admission rates for patients triaged as Level 1 immediate to Level 5 nonurgent were 43%, 30%, 13%, 3%, and 1%, respectively (<i>P</i><.0001). The mean total hospital charges for each of the 5 triage levels were $6,835, $5,283, $2,389, $872, and $445, respectively (<i>P</i><.0001). Similarly, there were significant differences in the means for laboratory, radiology, and pharmacy charges, ED lengths of stay, and CPT codes. Conclusion: The Soterion Rapid Triage System is a new, computerized, 5-level triage acuity system that possesses high interrater reliability and validity. The system's reliability and validity and functionality, and the availability of the system's electronically archived data, are characteristics beneficial to the development of a national standardized 5-level triage acuity system.