Research

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

Mohammed Khan Dalwai, Michele Twomey, Jacob Maikere, Shujaat Said, Muhammed Wakeel, Jean-Paul Jemmy, Pola Valles, Katie Tayler-Smith, Lee Wallis, Rony Zachariah

Abstract


Background. 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.

Objective. 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.

Methods. 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.

Results. 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%).

Conclusion. 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.


Authors' affiliations

Mohammed Khan Dalwai, Médecins Sans Frontières, Pakistan; Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Michele Twomey, Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Jacob Maikere, Médecins Sans Frontières, Pakistan

Shujaat Said, Médecins Sans Frontières, Pakistan

Muhammed Wakeel, Ministry of Health, Islamabad, Pakistan

Jean-Paul Jemmy, Médecins Sans Frontières, Medical Department (Operational Research), Operational Centre, Brussels, Belgium, MSF-Luxembourg (LuxOR), Luxembourg

Pola Valles, Médecins Sans Frontières, Medical Department (Operational Research), Operational Centre, Brussels, Belgium, MSF-Luxembourg (LuxOR), Luxembourg

Katie Tayler-Smith, Médecins Sans Frontières, Medical Department (Operational Research), Operational Centre, Brussels, Belgium, MSF-Luxembourg (LuxOR), Luxembourg

Lee Wallis, Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Rony Zachariah, Médecins Sans Frontières, Medical Department (Operational Research), Operational Centre, Brussels, Belgium, MSF-Luxembourg (LuxOR), Luxembourg

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Keywords

Triage; Emergency; South African Triage Scale

Cite this article

South African Medical Journal 2014;104(5):372-375. DOI:10.7196/SAMJ.7604

Article History

Date submitted: 2013-10-09
Date published: 2014-03-26

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