Reliability of a Computerized Version of the Pediatric Canadian Triage and Acuity Scale

Background: The use of a standardized triage tool allows better comparison of the patients; a computerized version could theoretically improve its reliability. Objectives: To compare the interrater agreement of the Pediatric Canadian Triage and Acuity Scale (PedCTAS) and a computerized version (Staturg). Methods: A two-phase experimental study was conducted to compare the interrater agreement between nurses assigning triage level to written case scenarios using either traditional PedCTAS or Staturg. Participants were nurses with at least one year of experience in pediatric emergency medicine and trained at triage. Each of the 54 scenarios was evaluated first by all nurses using either one of the strategies. Four weeks later, they evaluated the same scenarios using the other tool. The primary outcome was the interrater agreement measured using κ score. Results: Eighteen of the 29 eligible nurses participated in the study. The computerized triage tool showed a better interrater agreement, with a Staturg κ score of 0.55 (95% confidence interval = 0.53 to 0.57) versus a PedCTAS κ score of 0.51 (95% confidence interval = 0.49 to 0.53). The computerized version was also associated with higher agreements for scenarios describing patients with the highest severity of triage (κ score of 0.72 vs. 0.55 for level 1; κ score of 0.70 vs. 0.51 for level 2). Conclusions: A computerized version of the PedCTAS showed a statistically significant improvement in the interrater agreement for nurses evaluating the triage level of 54 clinical scenarios, but this difference has probably small clinical significance.