Emergency Department, University Hospital Basel, Basel, Switzerland.
Ann Emerg Med. 2011 Mar;57(3):257-64. doi: 10.1016/j.annemergmed.2010.07.021. Epub 2010 Oct 16.
To date, no German triage tool with proven reliability and validity exists. The goal of this project is to translate and culturally adapt the Emergency Severity Index (ESI) and to assess reliability and validity of the German version.
The ESI was translated following principles recommended for the translation and cultural adaptation of instruments. We performed a prospective, single-center cohort study. Reliability was assessed by calculating Cohen's weighted κ for agreement of 2 experts who reviewed the triage nurses' notes. To assess validity, associations of the number of resources, hospitalization, admission to intensive care, length of stay, and mortality with the assigned ESI level were investigated.
Only small cultural adaptations had to be made during the translation process. Interrater agreement was high (κ(w) = 0.985) in a sample of 125 patients. For the assessment of validity, a sample of 2,114 patients was used. Spearman's rank correlation coefficient between ESI category and number of resources was ρ = -0.567. The association (Kendall's τ) between ESI category and disposition, and hospitalization was τ = -0.429 and τ = -0.453, respectively. The areas under the curves for the predictive ability of the ESI for hospitalization in general and hospitalization to an ICU were 0.788 and 0.856, respectively. The association between emergency department length of stay and ESI category was also significant (Kruskal-Wallis χ² = 450.8; df = 4; P < .001). Furthermore, the association between ESI category and survival probability was significant (log-rank χ² = 36.06; df = 3; P < .001).
Translation of the ESI following guidelines was feasible and resulted in a reliable and valid German version.
迄今为止，尚无经过验证的可靠性和有效性的德国分诊工具。本项目的目标是翻译和文化适应紧急严重程度指数（ESI），并评估其德国版本的可靠性和有效性。
根据推荐的工具翻译和文化适应原则对 ESI 进行翻译。我们进行了一项前瞻性的单中心队列研究。通过计算 2 位专家审查分诊护士记录的一致性的 Cohen 加权κ，评估可靠性。为了评估有效性，研究了分配的 ESI 级别与资源数量、住院、入住重症监护病房、住院时间和死亡率之间的关联。
翻译过程中仅进行了少量文化调整。在 125 名患者的样本中，评分者间的一致性很高（κ（w）= 0.985）。为了评估有效性，使用了 2114 名患者的样本。ESI 类别和资源数量之间的Spearman 等级相关系数为 ρ = -0.567。ESI 类别与处置和住院之间的关联（Kendall 的τ）分别为τ= -0.429和τ= -0.453。ESI 对一般住院和 ICU 住院的预测能力的曲线下面积分别为 0.788 和 0.856。急诊科住院时间与 ESI 类别的关联也具有统计学意义（Kruskal-Wallis χ² = 450.8；df = 4；P <.001）。此外，ESI 类别与生存率之间的关联也具有统计学意义（对数秩 χ² = 36.06；df = 3；P <.001）。
按照指南翻译 ESI 是可行的，产生了可靠且有效的德语版本。
