法国与 ESI：两种护士分诊紧急量表与参照场景的比较。
FRENCH versus ESI: comparison between two nurse triage emergency scales with referent scenarios.
机构信息
Emergency medical service (SAMU 14), Caen University Hospital, Caen, France.
Emergency department, Lisieux Hospital, Lisieux, France.
出版信息
BMC Emerg Med. 2022 Dec 12;22(1):201. doi: 10.1186/s12873-022-00752-z.
OBJECTIVES
Acute triage is needed to prioritize care and achieve optimal resource allocation in busy emergency departments. The main objective is to compare the FRench Emergency Nurse Classification in Hospital scale (FRENCH) to the American scale Emergency Severity Index (ESI). Secondary objectives are to compare for each scale the over and under-triage, the triage matching to the gold standard and the inter-individual sorting reproducibility between the nurses.
METHODS
This is a prospective observational study conducting among the nursing staffs and nursing students, selected from Caen University College Hospital and Lisieux Hospital Center emergency departments between two months. Each group individually rank 60 referent clinical cases composed by scales designers. An assessment of scale practicality is collected after for each tool. The collected parameters are analyzed by a Cohen kappa concordance test (κ).
RESULTS
With 8151 triage results of gold standard scenarios sorting in two scales by the same nurses, the FRENCH scale seems to give better triage results than the US ESI scale (nurse: FRENCH 60% and ESI 53%, p = 0.003 ; nursing students: FRENCH 49% and ESI 42%, p < 0.001). In the two groups ESI has also a big tendency to under-sort (p = 0.01), particularly for the most severe patients (p < 0.01). The interobserver sorting concordance for any experience gives good results for the FRENCH and the ESI without any difference (nurses : FRENCH K=0.72 ESI K=0.78; p = 0.32 ; students K=0.44 K=0.55; p = 0.22).
CONCLUSION
The ESI and FRENCH scales comparison on 8151 sorting results shows direct validity in favor of FRENCH one and similar interobserver agreement for both scales.
目的
在繁忙的急诊科中，需要进行急性分诊以确定治疗优先级并实现最佳资源分配。主要目的是比较法国急诊护士分类医院规模（FRENCH）和美国急诊严重指数（ESI）。次要目标是比较每种量表的过度和不足分诊，与黄金标准的分诊匹配以及护士之间的个体排序可重复性。
方法
这是一项前瞻性观察性研究，在卡昂大学医院和利雪医院中心急诊科的护理人员和护理学生中进行，在两个月内进行选择。每个小组分别对由量表设计者组成的 60 个参考临床病例进行分级。在每个工具之后收集对量表实用性的评估。收集的参数通过 Cohen kappa 一致性检验（κ）进行分析。
结果
在由同一名护士对两种量表的 8151 个黄金标准场景进行分类后，FRENCH 量表似乎比美国 ESI 量表的分诊结果更好（护士：FRENCH 为 60%，ESI 为 53%，p=0.003；护理学生：FRENCH 为 49%，ESI 为 42%，p<0.001）。在两组中，ESI 也有很大的倾向于过度分诊（p=0.01），特别是对于最严重的患者（p<0.01）。任何经验的观察者之间的分类一致性对于 FRENCH 和 ESI 都给出了很好的结果，没有任何差异（护士：FRENCH K=0.72，ESI K=0.78；p=0.32；学生 K=0.44，K=0.55；p=0.22）。
结论
对 8151 种分类结果进行的 ESI 和 FRENCH 量表比较表明，FRENCH 量表具有直接有效性，并且两种量表的观察者间一致性相似。
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