Department of Emergency Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.
Department of Emergency Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
J Korean Med Sci. 2019 Jul 22;34(28):e189. doi: 10.3346/jkms.2019.34.e189.
All emergency centers in Korea use the Korean Triage and Acuity Scale (KTAS) as their initial triage tool. However, KTAS has been used without verification of its reliability. In this study, we assess the interrater agreement of KTAS by two independent nurses in real-time and analyse the factors which have an effect on the disagreement of KTAS levels.
This study was a prospective observational study conducted with patients who visited an emergency department (ED). Two teams, each composed of two nurses, triaged patients and recorded KTAS level and the main complaint from the list of 167 KTAS complaints, as well as modifiers. Interrater reliability between the two nurses in each team was assessed by weighted-kappa. Pearson's χ² test was conducted to determine if there were differences between each nurse's KTAS levels, depending on whether they chose the same complaints and the same modifiers or not.
The two teams triaged a total of 1,998 patients who visited the ED. Weighted-kappa value was 0.772 (95% confidence interval [CI], 0.750-0.794). Patients triaged by different chosen complaints showed (38.0%) higher inconsistency rate in KTAS levels than those triaged by the same complaint (10.9%, < 0.001). When nurses chose the same complaint and different modifiers, the ratio of different levels (50.5%) was higher than that of the same complaint and same modifier (8.1%, < 0.001).
This study showed that KTAS is a reliable tool. Selected complaints and modifiers are confirmed as important factors for reliability; therefore, selecting them properly should be emphasized during KTAS training courses.
韩国所有的急救中心都将韩国分诊和紧急程度分类系统（KTAS）作为其初始分诊工具。然而，KTAS 在未经可靠性验证的情况下就被使用了。在这项研究中，我们评估了两名独立护士实时使用 KTAS 的组内一致性，并分析了影响 KTAS 级别分歧的因素。
这是一项前瞻性观察研究，纳入了就诊于急诊部（ED）的患者。两个团队，每个团队由两名护士组成，对患者进行分诊，并记录 KTAS 级别以及从 167 个 KTAS 主诉中选择的主要主诉，以及修饰符。使用加权 Kappa 评估每个团队中两名护士之间的组内一致性。Pearson χ²检验用于确定两名护士的 KTAS 级别是否存在差异，取决于他们是否选择了相同的主诉和修饰符。
两个团队共分诊了 1998 名就诊于 ED 的患者。加权 Kappa 值为 0.772（95%置信区间 [CI]，0.750-0.794）。与选择相同主诉的患者相比，选择不同主诉的患者在 KTAS 级别上显示出（38.0%）更高的不一致率（10.9%，<0.001）。当护士选择相同的主诉和不同的修饰符时，不同级别（50.5%）的比例高于相同主诉和相同修饰符（8.1%，<0.001）的比例。
本研究表明 KTAS 是一种可靠的工具。选择的主诉和修饰符被确认为可靠性的重要因素；因此，在 KTAS 培训课程中应强调正确选择它们。
