Inter-rater agreement of the triage system RETTS-HEV

Eur J Emerg Med. 2014 Feb;21(1):37-41. doi: 10.1097/MEJ.0b013e32836397d9.


Objective: The purpose of this study was to evaluate the inter-rater agreement among nurses using the triage system RETTS-HEV (rapid emergency triage and treatment system - hospital unit west) in a Danish emergency department (ED).

Background: The use of triage systems in Denmark has been implemented recently together with structural changes in hospital organization. Testing and evaluation is therefore needed. The RETTS-HEV is a five-scale triage system being used in the ED of Herning, Denmark, since May 2010. The ED is semilarge, with 29 000 annual visits.

Materials and methods: Consecutive patients presenting to the ED were assessed by both a duty and a study nurse using RETTS-HEV. Nurses did not receive training before the study. In all, 146 patients were enroled and a blinded, paired and simultaneous triage was conducted independently to evaluate inter-rater agreement using Fleiss κ.

Results: A total of 155 patients were triaged over a 10-day period and complete data were available for 146 patients. We found the overall agreement to be good [Fleiss κ 0.60 (95% confidence interval 0.48; 0.72)]. The κ estimate was higher for the group of patients who required immediate attention [0.83 (95% confidence interval 0.18; 1.47)].

Conclusion: The study found good inter-rater agreement between two independent observers not receiving any new triage training before the study.

Publication types

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

MeSH terms

  • Algorithms
  • Decision Making, Computer-Assisted
  • Denmark
  • Emergency Nursing
  • Emergency Service, Hospital
  • Humans
  • Inservice Training
  • Outcome Assessment, Health Care
  • Prospective Studies
  • Reproducibility of Results
  • Triage / methods*
  • Triage / organization & administration