Inter-rater reliability of the Korean Triage and Acuity Scale performed between the prehospital and hospital stages

Woo, Jiwan; Lee, Sang-Hun; Kim, Tae kwon; Yoo, Jonghoon; Choi, Woo ik; Ju, Jeong Hee; Lee, Kyung-Woo

J Korean Soc Emerg Med > Volume 36(3); 2025 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2025;36(3): 112-120.

Inter-rater reliability of the Korean Triage and Acuity Scale performed between the prehospital and hospital stages

¹Department of Paramedicine, Sunlin University, Pohang, Korea
²Department of Emergency Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
³Daegu Fire Department, Daegu, Korea
⁴Department of Emergency Medicine, Daegu Catholic University School of Medicine, Daegu, Korea

Correspondence

Sang-Hun Lee ,Tel: 053-258-7896, Fax: 053-258-6305, Email: sanghun@dsmc.or.kr,

Received: April 19, 2024; Revised: July 24, 2024 Accepted: April 17, 2025. Published online: June 30, 2025.

ABSTRACT

Objective:
In Korea, patient evaluation faces limitations because of the differences in the triage system between the prehospital and hospital stages. To solve this problem, the Korean Triage and Acuity Scale (KTAS), a severity classification tool used in hospitals, is also used at the prehospital stage. Prehospital KTAS (pre-KTAS) is a new triage method used at this stage. However, there are few studies on the degree of agreement between prehospital and hospital evaluations. Therefore, we sought to evaluate the agreement between the pre-KTAS and KTAS triage.
Methods:
We conducted a retrospective observational study of patients who visited the emergency department at Keimyung University Dongsan Hospital via emergency medical services from November to December 2023. We compared the agreement between the pre-KTAS and KTAS triage and examined the differences according to certain subgroups.
Results:
Triage was performed on 503 patients, and a moderate agreement was observed between the pre-KTAS and KTAS triage results (weighted kappa, 0.572; 95% confidence interval [CI], 0.513-0.632; P<0.001). The agreement rate tended to be higher in patients with the same main symptoms (weighted kappa, 0.601; 95% CI, 0.537-0.666) or apparent symptoms such as fever (weighted kappa, 0.690; 95% CI, 0.590-0.791) and change of consciousness (weighted kappa, 0.627; 95% CI, 0.412-0.843).
Conclusion:
The agreement between the pre-KTAS and KTAS triage results appears to be moderate. The agreement is higher when there is an objective finding or matching of the main symptoms.

Key words: Triage; Emergency medical services; Hospital emergency service