The South African Triage Scale (adult version) provides reliable acuity ratings

Int Emerg Nurs. 2012 Jul;20(3):142-50. doi: 10.1016/j.ienj.2011.08.002. Epub 2011 Sep 17.


Objective: To estimate the inter- and intra-rater reliability of triage ratings on Emergency Centre patients by South African nurses and doctors using the South African Triage Scale (SATS).

Methods: A cross-sectional reliability study was performed. Five emergency physicians and ten enrolled nursing assistants independently assigned triage categories to 100 written vignettes unaware of the ratings given by others. Four different quantitative reliability measures were calculated and compared. Graphical displays portrayed rating distributions for vignettes with mean ratings at different acuity categories.

Results: The estimated quadratically weighted kappa for the group of emergency physicians was 0.76 (95% CI: 0.67-0.84) and for the group of nurses 0.66 (95% CI: 0.58-0.74). These values were close to the estimated intra-class correlation coefficients. For intra-rater reliability, the average exact agreement was 84%. The graphical displays showed that the least variability was evident in the vignettes that had a mean rating of 'emergency', 'very urgent' or 'routine'.

Conclusion: This study indicates good inter- and intra-rater reliability among nurses and doctors using the SATS. It suggests that the SATS is reliably applied, and supports the feasibility of further implementation of the SATS in similar settings.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Humans
  • Nursing Assistants
  • Nursing Staff, Hospital
  • Observer Variation
  • Physicians
  • Reproducibility of Results
  • South Africa
  • Triage / methods*