Interrater agreement between nurses for the Pediatric Canadian Triage and Acuity Scale in a tertiary care center

Acad Emerg Med. 2008 Dec;15(12):1262-7. doi: 10.1111/j.1553-2712.2008.00268.x. Epub 2008 Oct 17.


Objectives: The objective was to measure the interrater agreement between nurses assigning triage levels to children visiting a pediatric emergency departments (EDs) assisted by a computerized version of the Pediatric Canadian Triage and Acuity Scale (PedCTAS).

Methods: This was a prospective cohort study evaluating children triaged from Level 2 (emergent) to Level 5 (nonurgent). A convenience sample of patients triaged during 38 shifts from April to September 2007 in a tertiary care pediatric ED was evaluated. All patients were initially triaged by regular triage nurses using a computerized version of the PedCTAS. Research nurses performed a second evaluation blinded to the first evaluation using the same triage tool. These research nurses were regular ED nurses performing extra hours for research purposes exclusively. The primary outcome measure was the interrater agreement between the two nurses as measured by the linear weighted kappa score. Secondary outcomes included the proportion of patient for which nurses did not apply the triage level suggested by Staturg (override) and agreement for these overrides.

Results: A total of 499 patients were recruited. The overall interrater agreement was moderate (linear weighted kappa score of 0.55 [95% confidence interval {CI} = 0.48 to 0.61] and quadratic weighted kappa score of 0.61 [95% CI = 0.42 to 0.80]). There was a discrepancy of more than one level in only 10 patients (2% of the study population). Overrides occurred in 23.2 and 21.8% for regular and research triage nurses, respectively. These overrides were equally distributed between increase and decrease in triage level.

Conclusions: Nurses using Staturg, which is a computerized version of the PedCTAS, demonstrated moderate interrater agreement for assignment of triage level to children presenting to a pediatric ED.

Publication types

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

MeSH terms

  • Canada
  • Child
  • Child, Preschool
  • Cohort Studies
  • Decision Support Systems, Clinical*
  • Emergency Nursing / statistics & numerical data*
  • Female
  • Hospitals, Pediatric
  • Humans
  • Industry
  • Infant
  • Male
  • Pediatric Nursing / statistics & numerical data*
  • Prospective Studies
  • Reproducibility of Results
  • Severity of Illness Index
  • Triage / methods
  • Triage / statistics & numerical data*