• Olivier T Rutschmann, Olivier W Hugli, Christophe Marti, Olivier Grosgurin, Antoine Geissbuhler, Michel Kossovsky, Josette Simon, and François P Sarasin.
• Department of Community, Primary Care and Emergency Medicine, Division of Emergency Medicine.
• Eur J Emerg Med. 2018 Aug 1; 25 (4): 264-269.

BackgroundThe Swiss Emergency Triage Scale (SETS) is a four-level emergency scale that previously showed moderate reliability and high rates of undertriage due to a lack of standardization. It was revised to better standardize the measurement and interpretation of vital signs during the triage process.ObjectiveThe aim of this study was to explore the inter-rater and test-retest reliability, and the rate of correct triage of the revised SETS.Patients And MethodsThirty clinical scenarios were evaluated twice at a 3-month interval using an interactive computerized triage simulator by 58 triage nurses at an urban teaching emergency department admitting 60 000 patients a year. Inter-rater and test-retest reliabilities were determined using κ statistics. Triage decisions were compared with a gold standard attributed by an expert panel. Rates of correct triage, undertriage, and overtriage were computed. A logistic regression model was used to identify the predictors of correct triage.ResultsA total of 3387 triage situations were analyzed. Inter-rater reliability showed substantial agreement [mean κ: 0.68; 95% confidence interval (CI): 0.60-0.78] and test-retest almost perfect agreement (mean κ: 0.86; 95% CI: 0.84-0.88). The rate of correct triage was 84.1%, and rates of undertriage and overtriage were 7.2 and 8.7%, respectively. Vital sign measurement was an independent predictor of correct triage (odds ratios for correct triage: 1.29 for each additional vital sign measured, 95% CI: 1.20-1.39).ConclusionThe revised SETS incorporating standardized vital sign measurement and interpretation during the triage process resulted in high reliability and low rates of mistriage.

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