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J Korean Soc Emerg Med > Volume 30(4); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(4): 309-317.
한국형 응급환자 분류도구(Korean Triage and Acuity Scale) 적용 시 의사-간호사 간의 일치율 분석
김형일 , 오성범 , 최한주
단국대학교 의과대학 응급의학교실
Inter-rater agreement of Korean Triage and Acuity Scale between emergency physicians and nurses
Hyung Il Kim , Seong Beom Oh , Han Joo Choi
Department of Emergency Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
Correspondence  Han Joo Choi ,Tel: 041-550-6840, Fax: 041-556-0524, Email: iqtus@hanmai.net,
Received: October 17, 2018; Revised: January 24, 2019   Accepted: April 15, 2019.  Published online: August 30, 2019.
ABSTRACT
Objective:
The Korean Triage and Acuity Scale (KTAS) has been used in all emergency departments (EDs) since 2016. Medical personnel can provide the treatment priority based on the KTAS levels. The inter-rater agreement with KTAS has not been reported, even though most triage assignments are performed by nurses in Korea. This study was aimed to verify the agreement of triage levels between emergency physicians (EPs) and nurses with KTAS.
Method:
This was a prospective, single-center study of an academic tertiary medical center. If the patient visits the ED, the triage nurse and EP meet the patients together. The nurse performed the history taking and physical examinations including vital signs measurements then recorded the KTAS levels. The EP did not interfere with the nurse’s decision. The EP also decided the KTAS levels. The designated codes and levels were compared. The EP recorded the detailed reasons for the disagreement if there was discrepancy.
Results:
Comparisons were performed with 928 patients. The number of patients in each KTAS level was 95 (10.2%) in level I, 263 (28.3%) in level II, 348 (37.5%) in level III, 144 (15.5%) in level IV, and 78 (8.4%) in level V. The overall agreement was 761 (82%), and the Kappa coefficient was 0.691. The errors of history taking were most frequent (131, 78.4%). Insufficient understanding of the disease pathophysiology, inaccurate neurological examinations, and errors that did not consider the vital signs except for the blood pressure were encountered in 12 (7.2%).
Conclusion:
The agreement rate was high between EPs and nurses using KTAS (K=0.691, substantial agreement).
Key words: Triage; Interobserver; Observer variations
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