Smits Marleen, Plat Erik, Alink Elleke, Apotheker Maartje, Giesen Paul
Radboudumc, Scientific Center forQuality of Healthcare (IQ healthcare), Nijmegen.
Contact: Marleen Smits (
Ned Tijdschr Geneeskd. 2020 Aug 27;164:D4464.
To determine the inter-rater reliability and validity of the Netherlands Triage Standard (NTS) for paediatric triage.
A cross-sectional study using fictional cases for telephone and physical triage.
An expert panel established in advance the urgency of 40 cases concerning emergency help requests from non-referred children (the reference standard). These requests were presented in an online survey to triagists from three general practitioner (GP) out-of-hours practices, three ambulance dispatching centres and three hospital emergency departments. Triagists assessed all cases, using the NTS. We determined the agreement on degrees of urgency between different triagists and compared them with the reference standard. The outcome measure for inter-rater reliability was the intraclass correlation coefficient (ICC). The outcome measures for validity were the degree of agreement with the reference standard, under-triage and over-triage, and sensitivity and specificity in identifying high-urgency (U0-U2) versus low-urgency cases (U30U5).
In total, 116 triagists participated in the study (response: 86%). The ICC was 0.73 among all triagists, and was highest in the out-of-hours GP cooperatives. There was 62.3% agreement with the reference standard, 17.4% under-triage and 20.2% over-triage. Of the divergent urgencies, 77% differed by only one urgency category. The sensitivity was 85.2% and the specificity 89.7%. The sensitivity and specificity of triage by the GP out-of-hours practices (82.7% and 92.7%, respectively) were almost the same as that by the hospital emergency departments (79.6% and 92.5%, respectively). Triage by the ambulance dispatching centres had relatively high sensitivity (93%), but relatively low specificity (82.4%).
The results of the study contribute to the evidence that the NTS is a reliable and valid triage standard for paediatric patients. The urgency assessments by triagists in the GP out-of-hours practices, ambulance dispatching centres and hospital emergency departments were broadly in agreement. Results were limited by cases being on paper and triage only on anamnestic characteristics.
确定荷兰儿科分诊标准（NTS）在不同评估者之间的可靠性和有效性。
一项横断面研究，使用虚构病例进行电话分诊和现场分诊。
一个专家小组预先确定了40例非转诊儿童紧急求助病例的紧急程度（参考标准）。这些求助信息通过在线调查呈现给来自三个全科医生（GP）非工作时间诊所、三个救护车调度中心和三个医院急诊科的分诊人员。分诊人员使用NTS对所有病例进行评估。我们确定了不同分诊人员之间在紧急程度上的一致性，并将其与参考标准进行比较。评估者间可靠性的结果指标是组内相关系数（ICC）。有效性的结果指标是与参考标准的一致程度、分诊不足和分诊过度情况，以及识别高紧急程度（U0 - U2）与低紧急程度病例（U3 - U5）的敏感性和特异性。
共有116名分诊人员参与了该研究（回复率：86%）。所有分诊人员的ICC为0.73，在非工作时间的全科医生合作诊所中最高。与参考标准的一致性为62.3%，分诊不足为17.4%，分诊过度为20.2%。在不同的紧急程度差异中，77%仅相差一个紧急程度类别。敏感性为85.2%，特异性为89.7%。全科医生非工作时间诊所分诊的敏感性和特异性（分别为82.7%和92.7%）与医院急诊科的几乎相同（分别为79.6%和92.5%）。救护车调度中心的分诊敏感性相对较高（93%），但特异性相对较低（82.4%）。
该研究结果为NTS是儿科患者可靠且有效的分诊标准这一证据提供了补充。全科医生非工作时间诊所、救护车调度中心和医院急诊科的分诊人员对紧急程度的评估大致一致。研究结果受限于病例为纸质形式且仅根据记忆特征进行分诊。
