Henning Brita, Lydersen Stian, Døllner Henrik
Department of Pediatrics, St. Olav's University Hospital, Trondheim, Norway.
Regional Centre for Child and Youth Mental Health and Child Welfare, Trondheim, Norway.
Scand J Trauma Resusc Emerg Med. 2016 Feb 24;24:19. doi: 10.1186/s13049-016-0207-6.
To evaluate inter- and intrarater reliability of a new Scandinavian triage system for children, the Rapid Emergency Triage and Treatment System-pediatric (RETTS-p).
Two observational studies were conducted at the Pediatric Emergency Department (PED), St. Olav's University Hospital, Trondheim, Norway. Using RETTS-p, nurses assign one of five triage priority levels to each patient on the basis of clinical signs and symptoms evaluations and vital parameter measurements. Study 1: Prior to the introduction of RETTS-p in 2012, all nurses in the PED completed a theoretical and practical training. Four months later, 19 nurses triaged 20 fictive but realistic pediatric cases two times 9 months apart (Waves A and B). Study 2: Nurse pairs consisting of a regular nurse and a research nurse simultaneously and independently triaged 200 pediatric patients who were referred with various common medical and surgical complaints.
Study 1: Kendall's W for Waves A and B were 0.822 and 0.844, respectively. Using a mixed linear model, we found no difference in triage priority levels between Waves A and B. Compared to a consensus level made by the research group, the nurses rated 85.1 % fictive cases correctly, and 99 % were rated correctly or within one adjacent priority score. Study 2: The interrater correlation coefficient in a linear mixed model was 0.762, confirming a high interrater reliability in real-life triaging.
We found a very high degree of agreement between nurses who used RETTS-p to prioritize children, both in a theoretical case scenarios study, but also in real-life triaging.
RETTS-p may be a credible and robust triage system, but it has not been validated yet.
为评估一种新的针对儿童的斯堪的纳维亚分诊系统——快速急诊分诊与治疗系统-儿科版（RETTS-p）的评分者间信度和评分者内信度。
在挪威特隆赫姆市圣奥拉夫大学医院儿科急诊科（PED）进行了两项观察性研究。使用RETTS-p，护士根据临床体征和症状评估以及生命体征参数测量为每位患者分配五个分诊优先级别之一。研究1：在2012年引入RETTS-p之前，PED的所有护士完成了理论和实践培训。四个月后，19名护士对20个虚拟但逼真的儿科病例进行了两次分诊，间隔9个月（A波和B波）。研究2：由一名普通护士和一名研究护士组成的护士对同时且独立地对200名因各种常见内科和外科疾病前来就诊的儿科患者进行分诊。
研究1：A波和B波的肯德尔W系数分别为0.822和0.844。使用混合线性模型，我们发现A波和B波之间的分诊优先级别没有差异。与研究组达成的共识级别相比，护士对85.1%的虚拟病例评分正确，99%的病例评分正确或在相邻的一个优先分数范围内。研究2：线性混合模型中的评分者间相关系数为0.762，证实了在实际分诊中具有较高的评分者间信度。
我们发现，无论是在理论病例场景研究还是在实际分诊中，使用RETTS-p对儿童进行优先排序的护士之间都达成了高度一致。
RETTS-p可能是一个可靠且稳健的分诊系统，但尚未经过验证。
