Department of Gynaecology and Obstetrics, Lausanne University Hospital and Faculty of Medicine, Lausanne, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
BJOG. 2017 Nov;124(12):1867-1873. doi: 10.1111/1471-0528.14535. Epub 2017 Mar 15.
To evaluate the reliability of a four-level triage scale for obstetrics and gynaecology emergencies and to explore the factors associated with an optimal triage.
Thirty clinical vignettes presenting the most frequent indications for obstetrics and gynaecology emergency consultations were evaluated twice using a computerised simulator.
The study was performed at the emergency unit of obstetrics and gynaecology at the Geneva University Hospitals.
The vignettes were submitted to nurses and midwives.
We assessed inter- and intra-rater reliability and agreement using a two-way mixed-effects intra-class correlation (ICC). We also performed a generalised linear mixed model to evaluate factors associated triage correctness.
Triage acuity.
We obtained a total of 1191 evaluations. Inter-rater reliability was good (ICC 0.748; 95% CI 0.633-0.858) and intra-rater reliability was almost perfect (ICC 0.812; 95% CI 0.726-0.889). We observed a wide variability: the mean number of questions varied from 6.9 to 18.9 across individuals and from 8.4 to 16.9 across vignettes. Triage acuity was underestimated in 12.4% of cases and overestimated in 9.3%. Undertriage occurred less frequently for gynaecology compared with obstetric vignettes [odds ratio (OR) 0.45; 95% CI 0.23-0.91; P = 0.035] and decreased with the number of questions asked (OR 0.94; 95% CI 0.88-0.99; P = 0.047). Certification in obstetrics and gynaecology emergencies was an independent factor for the avoidance of undertriage (OR 0.35; 95% CI 0.17-0.70; P = 0.003).
The four-level triage scale is a valid and reliable tool for the integrated emergency management of obstetrics and gynaecology patients.
The Swiss Emergency Triage Scale is a valid and reliable tool for obstetrics and gynaecology emergency triage.
评估妇产科急症四级分诊量表的可靠性，并探讨与最佳分诊相关的因素。
使用计算机模拟器评估了 30 个呈现妇产科急诊最常见指征的临床病例，两次评估均采用该模拟器进行。
该研究在日内瓦大学附属医院妇产科急诊部进行。
该病例提交给护士和助产士。
使用双向混合效应组内相关系数（ICC）评估了组内和组间的可靠性和一致性。我们还进行了广义线性混合模型，以评估与分诊准确性相关的因素。
分诊的紧迫性。
我们共获得了 1191 次评估。组间可靠性良好（ICC 0.748；95%CI 0.633-0.858），组内可靠性几乎完美（ICC 0.812；95%CI 0.726-0.889）。我们观察到很大的变异性：个体间的平均问题数从 6.9 到 18.9 不等，病例间从 8.4 到 16.9 不等。在 12.4%的情况下，分诊的紧迫性被低估，在 9.3%的情况下被高估。与妇产科病例相比，妇科病例的分诊不足发生率较低[比值比（OR）0.45；95%CI 0.23-0.91；P = 0.035]，且随着询问问题的数量增加而减少（OR 0.94；95%CI 0.88-0.99；P = 0.047）。妇产科急症认证是避免分诊不足的独立因素（OR 0.35；95%CI 0.17-0.70；P = 0.003）。
四级分诊量表是一种有效的、可靠的妇产科患者综合急诊管理工具。
