Agreement among pediatric health care professionals with the pediatric Canadian triage and acuity scale guidelines

Pediatr Emerg Care. 2004 Aug;20(8):514-8. doi: 10.1097/


Objectives: To compare triage level assignment, using case scenarios, in a pediatric emergency department between registered nurses (RNs) and pediatric emergency physicians (PEPs) based on the Pediatric Canadian Triage and Acuity Scale (P-CTAS) guidelines. To compare triage level assignment of the RNs and PEPs to that done by a panel of experts using the same P-CTAS guidelines.

Methods: A cross-sectional questionnaire survey (55 case scenarios) was sent to all RNs and PEPs working in the emergency department after the P-CTAS was implemented. Participants were instructed to assign a triage level for each case. A priori, all cases were assigned a triage level by a panel of experts using the P-CTAS guidelines. Kappa statistics and the mean number (+/-1SD) of correct responses were calculated.

Results: A response rate of 85% was achieved (29 RNs, 15 PEPs). The kappa level of agreement (95% CI) among RNs was 0.51 (0.50-0.52) and was 0.39 (0.38-0.41) among PEPs (P < 0.001). The mean number of correct responses (+/-1SD) for RNs was 64% +/- 27% and for PEPs 60% +/- 22% (P = 0.31). Levels of agreement did not vary according to experience or type of shift work done or work status of RNs and PEPs.

Conclusions: With the introduction of the P-CTAS, the level of agreement and accuracy of triage categorization remained moderate for both RNs and PEPs. The reliability of the P-CTAS needs to be further assessed and the requirements for revisions considered prior to its widespread use.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Attitude of Health Personnel*
  • Canada
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Emergency Medical Services*
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Nurses / psychology*
  • Pediatrics*
  • Physicians / psychology*
  • Practice Guidelines as Topic*
  • Severity of Illness Index*
  • Surveys and Questionnaires
  • Triage*