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http://dx.doi.org/10.22650/JKCNR.2020.26.1.107

Inter-Rater Reliability of the Korean Triage and Acuity Scale  

Son, Jeong Ah (Department of Nursing, The Catholic University of Korea, Incheon ST. Mary's Hospital)
Lee, Eun Ja (College of Nursing, Gachon University)
Publication Information
Journal of Korean Clinical Nursing Research / v.26, no.1, 2020 , pp. 107-116 More about this Journal
Abstract
Purpose: This study was a prospective survey to evaluate the Korean Triage and Acuity Scale (KTAS) inter-rater reliability and to identify discordant areas in the KTAS classification between nurses and paramedics in emergency department (ED). Methods: Inter-rater reliability were evaluated using triage deta from January 11 to May 31, 2019. A convinience sample of a total of 800 patients who visited an emergnecy medical center in Incheon (400 adult and 400 pediatric patients in this study) were selected. The triages of this study a pair of one nurse and one paramedic performed triage at the same time, using the KTAS, Inter-rater reliability for the KTAS was evaluated with the weighted kappa. Results: The inter-rater reliability of the KTAS evaluated by weighted Kappa between nurse-paramedic KTAS score of adult patients was .71, and .66 for pediatric patients. Both were in the level considered as substantial. Among causes of triage discordance, the most frequently identified discordant item in triaging adults was the difference in the measurement of pain intensity (28.0%). For both adult and pediatric patients, multiple chief complaint was identified as the major discordant factor. In triaging pediatric patients the body temperature assessment by subjective judgments was the highest discordant item (50.7%). Conclusion: The study result suggested that the KTAS demonstrated a reasonable level of inter-rater reliability and functioned as a standardized triage tool for emergency medical services. In order to improve the inter-rater reliability and classification competence, it is necessary to revise the current all-integrated KTAS provider course to be differentiated for each job group.
Keywords
Emergency Department; Triage; Nurses; Paramedics; Reliability;
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1 Ministry of Health and Welfare. Reliability and validity verification study of the Korean Triage and Acuity Scale(KTAS) [Internet]. Sejong: The Korean Society of Emergency Medicine; c2014 [cited 2019 Sep 24]. Available from: http://www.prism.go.kr/homepage/entire/retrieveEntireDetail.do?pageIndex=1&research_id=1351000-201400241&left-MenuLevel=160&cond_research_name.
2 The National Law Information Center. Enforcement rule of the Emergency medical service act Article 18-3 [Internet]. Sejong: The National Law Information Center; c2016-2018 [cited 2019 Sep 24]. Available from: http://www.law.go.kr/LSW//lsInfoP.do?lsiSeq=215303&chrClsCd=010202&urlMode=lsInfoP&efYd=20200228#0000.
3 Takahashi T, Inoue N, Shimizu N, Terakawa T, Goldman RD. 'Down-triage' for children with abnormal vital signs: Evaluation of a new triage practice at a paediatric emergency department in Japan. Emergency Medicine Journal. 2016;33(8):533-537. https://doi.org/10.1136/emermed-2015-204968   DOI
4 Moon SH, Shim JL. Triage accuracy of pediatric patients using the Korean Triage and Acuity Scale in emergency departments. Journal of the Korea Academia-Industrial cooperation Society. 2018;19(11):626-634. https://doi.org/10.5762/KAIS.2018.19.11.626   DOI
5 Noh H. Develpoment of an improved model of the Korean Triage and Acuity Scale for children [dissertation]. Chuncheon: Kangwon National University; 2017. p. 1-94.
6 Kim JY, Hong DY, Kim SY, Kim JW, Park SO, Lee KR, et al. Reliability of Korean Triage and Acuity Scale-based triage system as a severity index in emergency patients. Journal of the Korean Society of Emergency Medicine. 2017;28(6):552-556.
7 Yang JE. Inter-rater reliability of the Korean Triage and Acuity Scale(KTAS) [master's thesis]. Incheon: Gachon University; 2018. p. 1-68.
8 Park JB. KTAS is different. In: Proceedings of the 2018 Korea Emergency Medicine Conference; 2018 Apr 19-20; Hwabaek International Convention Center, Gyeongju. Seoul: The Korean Society of Emergency Medicine; 2018. p. 1-3.
9 Korean Triage and Acuity Scale(KTAS) Committee. KTAS Curriculum Introduction [Internet]. Seoul: The Korean Society of Emergency Medicine KTAS Committee; c2019 [cited 2019 Sep 24]. Available from: http://www.ktas.org/education/info.php.
10 Oh JH. How do you like to use KTAS?: User survey at the time of one year. In: Proceedings of the 2017 Korea Emergency Medicine Conference; 2017 Apr 20-21; Kimdaejung Convention Center, Gwangju. Seoul: The Korean Society of Emergency Medicine; 2017. p. 100-106.
11 Ministry of Health and Welfare, National Fire Agency. Development of Prehospital Korean Triage and Acuity Scale (Prehospital KTAS) [Internet]. Sejong: The Korean Society of Emergency Medicine; c2017 [cited 2019 Sep 24]. Available from: http://www.prism.go.kr/homepage/entire/retrieveEntireDetail.do?research_id=1351000-201700281.
12 Bujang MA, Baharum N. Guidelines of the minimum sample size requirements for Kappa agreement test. Epidemiology Biostatistics and Public Health. 2017;14(2):e12267. https://doi.org/10.2427/12267
13 Korean Triage and Acuity Scale(KTAS) Committee. Korean Triage and Acuity Scale manual Version 1.0 [Internet]. Seoul: The Korean Society of Emergency Medicine KTAS Committee; c2014 [cited 2019 Sep 24]. Available from: http://www.prism.go.kr/homepage/entire/retrieveEntireDetail.do?pageIndex=1&research_id=1351000-201400241&leftMenuLevel=160&cond_research_name=%EC%A4%91%EC%A6%9D%EB%8F%84+%EB%B6%84%EB%A5%98&cond_research_start_date=&cond_research_end_date=&pageUnit=10&cond_order=3.
14 Kim MH. Reliability and validity of the Korean Triage and Acuity Scale [master's thesis]. Suwon: Ajou University; 2017. p. 1-52.
15 Park CU, Kim HJ. Measurement of inter-rater reliability in systematic review. Hanyang Medical Reviews. 2015;35(1):44-49. https://doi.org/10.7599/hmr.2015.35.1.44   DOI
16 Lee KH. How to developed and use the KTAS(Korean Triage and Acuity Scale). In: Proceedings of the 2013 Korea Emergency Medicine Conference; 2013 Apr 18-19; High1 Resort, Jeongseongun. Seoul: The Korean Society of Emergency Medicine; 2013. p. 417-424.
17 National Emergency Medical Center. 2018 National Emergency Department Information System(NEDIS) statistics annual report. Seoul: Ministry of Health and Welfare, National Emergency Medical Center; 2018 Dec. Report No.:11-B552657-000007-10.
18 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-174. https://doi.org/10.2307/2529310   DOI
19 McHugh ML. Interrater reliability: the kappa statistic. Biochemia Medica. 2012;22(3):276-282. https://doi.org/10.11613/BM.2012.031   DOI
20 Considine J, LeVasseur SA, Villanueva E. The Australasian Triage Scale: Examining emergency department nurses' performance using computer and paper scenarios. Annals of Emergency Medicine. 2004;44(5):516-523. https://doi.org/10.1016/j.annemergmed.2004.04.007   DOI
21 Moon SH, Park YH. Thinking strategies of triage nurses' decision making in the emergency department: Think aloud study. Journal of Korean Critical Care Nursing. 2016;9(1):15-26.
22 Mackway-Jones K, Marsden J, Jill W. Emergency triage: Manchester Triage Group. 3rd ed. Oxford(UK): John Wiley & Sons; 2014.
23 Yun JG, Lee YH, Jeong JY. Emergency medical technician's works within hospital at partial areas. The Korean Journal of Emergency Medical Services. 2005;9(2):21-28.
24 Ministry of Health and Welfare. Standardization study of emergency triage system [Internet]. Sejong: The Korean Society of Emergency Medicine; c2012 [cited 2019 Sep 24]. Available from: http://www.prism.go.kr/homepage/entire/retrieveEntireDetail.do?pageIndex=3&research_id=1351000-201300160&leftMenuLevel=160&cond_research_name=%EC%9D%91%EA%B8%89&cond_research_start_date=&cond_research_end_date=&pageUnit=10&cond_order=3.
25 Kim JH. A study on the scope of practice for emergency medical technician in the law regarding the emergency care [dissertation]. Yongin: Dankook University; 2019. p. 178-179.
26 Choi HK, Choi MJ, Kim JW, Lee JY, Shin SH, Lee HJ. Reliability of the emergency severity index version 4 performed by trained triage nurse. Journal of Korean Critical Care Nursing. 2012;5(2):61-71.
27 National Emergency Medical Center. 2017 statistics of emergency medical services [Internet]. Seoul: National Emergency Medical Center; c2018 [cited 2019 Sep 24]. Available from: https://www.e-gen.or.kr/nemc/statistics_annual_report.do.
28 Shin SD, Jo YH, Cheon SB, Jung SK, Kwak YH, Rhee JE, et al. Effect of emergency department overcrowding on the outcome of patient care: A pilot study. Journal of the Korean Society of Emergency Medicine. 2004;15(1):1-7.
29 Lim TH, Park JB, Je SM. Pediatric Korean triage and acuity scale. Pediatric Emergency Medicine Journal. 2015;2(2):53-58. https://doi.org/10.22470/pemj.2015.2.2.53   DOI
30 Fernandes MB, Tanabe P, Gilboy N, Johnson LA, McNair RS, Rosenau AM, et al. Five-level triage: A report from the ACEP/ENA Five-level Triage Task Force. Journal of Emergency Nursing. 2005;31(1):39-50. https://doi.org/10.1016/j.jen.2004.11.002   DOI