Buschhorn Holly M, Strout Tania D, Sholl J Matthew, Baumann Michael R
Department of Emergency Medicine, St Mary’s Hospital & Regional Medical Center, Grand Junction, CO, USA.
J Emerg Nurs. 2013 Sep;39(5):e55-63. doi: 10.1016/j.jen.2011.11.003. Epub 2012 Jan 13.
Efficient communication between emergency medical services (EMS) and ED providers using a common triage system may enable more effective transfers when EMS arrives in the emergency department. We sought (1) to evaluate inter-rater reliability between Emergency Severity Index (ESI) assignments designated by EMS personnel and emergency triage nurses (registered nurses [RNs]) and (2) to evaluate the validity of EMS triage assignments using the ESI instrument.
This prospective, observational study evaluated inter-rater reliability in ESI scores assigned by prehospital personnel and RNs. EMS providers were trained to use the ESI by the same methods used for nurse training. EMS personnel assigned triage scores to patients independent of assignments by the RN. Inter-rater reliability, differences based on provider experience, and validity of EMS triage assignments (sensitivity and specificity) were evaluated.
Seventy-five paired, blinded triages were completed. Overall concordance between EMS providers and RNs was 0.409 (95% confidence interval [CI], 0.256-0.562). Agreement for EMS providers with less experience was 0.519 (95% CI, 0.258-0.780), whereas concordance for those with more experience was 0.348 (95% CI, 0.160-0.536; χ(2) = 1.413, df = 1, P = .235). Sensitivity ranged from 0% to 67.86%. Specificity ranged from 68.09% to 97.26%.
We observed moderate concordance between EMS and RN ESI triage assignments. EMS sensitivity for correct acuity assignment was generally poor, whereas specificity for correctly not assigning a particular level was better. Additional research investigating the potential causes of the poor agreement that we observed is warranted.
使用通用分诊系统，紧急医疗服务（EMS）与急诊科医护人员之间进行高效沟通，可能会使EMS抵达急诊科时实现更有效的转运。我们旨在（1）评估EMS人员与急诊分诊护士（注册护士[RN]）指定的急诊严重程度指数（ESI）分级之间的评分者间信度，以及（2）使用ESI工具评估EMS分诊分级的有效性。
这项前瞻性观察性研究评估了院前急救人员和注册护士指定的ESI评分的评分者间信度。通过与护士培训相同的方法对EMS医护人员进行ESI使用培训。EMS人员独立于注册护士的分级为患者分配分诊分数。评估了评分者间信度、基于医护人员经验的差异以及EMS分诊分级的有效性（敏感性和特异性）。
完成了75对双盲分诊。EMS医护人员与注册护士之间的总体一致性为0.409（95%置信区间[CI]，0.256 - 0.562）。经验较少的EMS医护人员的一致性为0.519（95%CI，0.258 - 0.780），而经验较多的医护人员的一致性为0.348（95%CI，0.160 - 0.536；χ(2)=1.413，自由度=1，P = 0.235）。敏感性范围为0%至67.86%。特异性范围为68.09%至97.26%。
我们观察到EMS与注册护士的ESI分诊分级之间存在中等程度的一致性。EMS对正确 acuity 分级的敏感性总体较差，而正确不分配特定级别的特异性较好。有必要进行进一步研究，以调查我们观察到的一致性较差的潜在原因。
