Twomey Michèle, Wallis Lee A, Myers Jonathan E
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
Occupational and Environmental Health Research Unit, University of Cape Town, Cape Town, South Africa.
Emerg Med J. 2014 Jul;31(7):562-566. doi: 10.1136/emermed-2013-202352. Epub 2013 Apr 24.
To evaluate the construct of triage acuity as measured by the South African Triage Scale (SATS) against a set of reference vignettes.
A modified Delphi method was used to develop a set of reference vignettes. Delphi participants completed a 2-round consensus-building process, and independently assigned triage acuity ratings to 100 written vignettes unaware of the ratings given by others. Triage acuity ratings were summarised for all vignettes, and only those that reached 80% consensus during round 2 were included in the reference set. Triage ratings for the reference vignettes given by two independent experts using the SATS were compared with the ratings given by the international Delphi panel. Measures of sensitivity, specificity, associated percentages for over-triage/under-triage were used to evaluate the construct of triage acuity (as measured by the SATS) by examining the association between the ratings by the two experts and the international panel.
On completion of the Delphi process, 42 of the 100 vignettes reached 80% consensus on their acuity rating and made up the reference set. On average, over all acuity levels, sensitivity was 74% (CI 64% to 82%), specificity 92% (CI 87% to 94%), under-triage occurred 14% (CI 8% to 23%) and over-triage 12% (CI 8% to 23%) of the time.
The results of this study provide an alternative to evaluating triage scales against the construct of acuity as measured with the SATS. This method of using 80% consensus vignettes may, however, systematically bias the validity estimate towards better performance.
根据一组参考病例 vignettes，评估南非分诊量表（SATS）所测量的分诊 acuity 的结构。
采用改良德尔菲法制定一组参考病例 vignettes。德尔菲参与者完成两轮共识达成过程，并独立为 100 个书面病例 vignettes 分配分诊 acuity 评级，且不知道其他人给出的评级。汇总所有病例 vignettes 的分诊 acuity 评级，只有在第二轮中达成 80%共识的病例 vignettes 才被纳入参考集。将两名独立专家使用 SATS 对参考病例 vignettes 的分诊评级与国际德尔菲小组给出的评级进行比较。通过检查两位专家和国际小组的评级之间的关联，使用灵敏度、特异性、过度分诊/分诊不足的相关百分比等指标来评估分诊 acuity（通过 SATS 测量）的结构。
在德尔菲过程完成后，100 个病例 vignettes 中有 42 个在 acuity 评级上达成了 80%的共识，并构成了参考集。总体而言，在所有 acuity 水平上，平均灵敏度为 74%（CI 64%至 82%），特异性为 92%（CI 87%至 94%），分诊不足发生的时间为 14%（CI 8%至 23%），过度分诊为 12%（CI 8%至 23%）。
本研究结果为根据 SATS 测量的 acuity 结构评估分诊量表提供了一种替代方法。然而，这种使用 80%共识病例 vignettes 的方法可能会使有效性估计系统性地偏向更好的表现。
