Prospective evaluation of two emergency triage scales: the French Emergency Nurses Classification in Hospitals (FRENCH) and the Emergency Severity Index (ESI)
No. 28 (2020), Orginal Article
No. 28 (2020)

Prospective evaluation of two emergency triage scales: the French Emergency Nurses Classification in Hospitals (FRENCH) and the Emergency Severity Index (ESI)

Orginal Article
Published 2021-04-11
Antoine Aubrion
1. Emergency medical service (SAMU 14), Caen University Hospital, Caen, France 2. Emergency department, Lisieux Hospital, Lisieux, France
R Clanet
1. Emergency department, Bayeux Hospital, Bayeux, France 2. Emergency department, Bayeux Hospital, Bayeux, France
A Guigne
1. Emergency department, Bayeux Hospital, Bayeux, France 2. Emergency department, Caen University Hospital, Caen, France 3. Normandy University, medical school, UNICAEN, Caen, France
N Lecadet
1. Emergency department, Bayeux Hospital, Bayeux, France 2. Emergency department, Bayeux Hospital, Bayeux, France
S Audigie
1. Emergency department, Bayeux Hospital, Bayeux, France 2. Emergency department, Caen University Hospital, Caen, France
Ch Creveuil
Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France
E Roupie
1. Emergency department, Bayeux Hospital, Bayeux, France 2 . Normandy University, medical school, UNICAEN, Caen, France
R Macrez
1. Emergency department, Bayeux Hospital, Bayeux, France 2. Emergency department, Caen University Hospital, Caen, France 3. Normandy University, medical school, UNICAEN, Caen, France 4. Normandy University, UNICAEN, INSERM, INSERM UMR-S U1237, Physiopathology and Imaging for Neurological Disorders (PhIND), Cyceron, Caen, France
PDF

Keywords

Accident and Emergency department
Emergency
ESI
FRENCH Triage

How to Cite

Aubrion, A. ., Clanet , R., Guigne , A., Lecadet , N., Audigie , S., Creveuil , C., Roupie , E., & Macrez , R. (2021). Prospective evaluation of two emergency triage scales: the French Emergency Nurses Classification in Hospitals (FRENCH) and the Emergency Severity Index (ESI). Mediterranean Journal of Emergency Medicine, (28), 8-12. Retrieved from http://ojs.mjemonline.com/index.php/mjem/article/view/93
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver

Download Citation

Endnote/Zotero/Mendeley (RIS) BibTeX

Abstract

Objective(s): Emergency Departments (ED) require a systematic approach to prioritize patient care depending on acuity. The Emergency Severity Index (ESI) scale is the most used. In France, the French Emergency Nurses’ Classification in Hospitals (FRENCH) is used. The aim of this study was to evaluate inter-rater reliability and validity of the ESI and FRENCH triage scales.

Methods: We performed a prospective monocentric study in a French University College Hospital over the 2016 summer. All patients admitted to ED were evaluated to the triage area by two pairs of emergency physicians, each unaware of the triage results of the other pair. Reliability was estimated by a quadratic weighted Kappa. Validity was evaluated by the association between the level of triage and the following indirect criteria: rate of admission, type of admission amount of resources and length of stay in the emergency ward.

Results: Both the ESI and FRENCH triage systems showed strong reliability (weighted Kappa respectively 0.85 and 0.87) without any significant difference. An association was established for both scales between the level of emergency and each of the indirect criteria of validity. The associations between triage level and the amount of resources and length of stay criteria were significantly stronger for ESI scale. The area under the Receiver Operating Characteristic curve for prediction of an admission was 0.75 for ESI and 0.71 for FRENCH scale without any significant difference.

Conclusion: ESI and FRENCH scales have a strong inter-rater reliability and appear to have a good validity. Other studies, particularly multicenter studies including more qualitative criteria, would probably make it possible to decide on the most effective triage method.

PDF

References

Baumann MR, Strout TD. Triage of geriatric patients in the emergency

department: validity and survival with the emergency severity index. Ann Emerg Med 2007; 49:234-40.

Widgren BR, Jourak M. Medical emergency triage and treatment system (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med 2011; 40:623-8.

Farrohknia N, Castrén M, Ehrenberg A, Lind L, Oredsson S, Jonsson H, et al. Emergency department triage scales and their components: a systematic review of the scientific evidence. Scand J Trauma Resusc Emerg Med 2011; 19:42.

Chauvin A, Truchot J, Ouled N, Plaisance P, Segal N. Evaluation of a new triage scale on patients’ classification in a teaching emergency department: a retrospective study. Med Emergency, MJEM 2016; 24:5-10.

Taboulet P, Fontaine JP, Afdjei A, Tran C, Le Gall JR. Triage aux urgences par une infirmière d’accueil et d’orientation. Influence sur la durée d’attente et la satisfaction des consultants aux urgences. Réa Urgences 1997; 4:433-42.

Fernandes CMB, Tanabe P, Gilboy N, Johnson LA, McNair RS, Rosenau AM, et al. Five-level triage: a report from the ACEP/ENA Five-level triage task force. J Emerg Nurs 2005; 31:39-50.

Tanabe P, Gimbel R, Yarnold PR, Kyriacou DN, Adams JG. Reliability and validity of scores on the emergency severity index version 3. Acad Emerg Me 2004; 11:59-65.

Esmailian M, Zamani M, Azadi F, Ghasemi F. Inter-Rater agreement of emergency nurses and physicians in Emergency Severity Index (ESI) Triage. Emerg (Tehran). 2014; 2:158-61.

Mirhaghi A, Heydari A, Mazlom R, Hasanzadeh F. Reliability of the emergency severity index: Meta-analysis. Sultan Qaboos Univ Med J. 2015; 15:e71-7.

Christ M, Grossmann F, Winter D, Bingisser R, Platz E. Modern triage in the emergency department. Dtsch Arzteblatt Int 2010; 107:892-8.

Grossmann FF, Nickel CH, Christ M, Schneider K, Spirig R, Bingisser R. Transporting clinical tools to new settings: cultural adaptation and validation of the emergency severity index in German. Ann Emerg Med 2011; 57:257-64.

Bergs J, Verelst S, Gillet J-B, Vandijck D. Evaluating implementation of the emergency severity index in a Belgian hospital. J Emerg Nurs 2014; 40:592-7.

Fehre A, Chauvin A, Durand-Stocco C, Ouled N, Plaisance P, Segal N. Évaluation de l’application d’un triage par la classification infirmière des malades aux urgences par des infirmiers organisateurs de l’accueil en comparaison avec un triage réalisé par un médecin. Ann Fr Med Urg 2015; 5:150-8.

Taboulet P, Moreira V, Haas L, Porcher R, Braganca A, Fontaine J-P, et al. Triage with the french emergency nurses classification in hospital scale: reliability and validity. Eur J Emerg Med 2009; 16:61-7.

Gilboy N, Tanabe T, Travers D, Rosenau AM. Emergency severity index (ESI): A triage tool for emergency department care, version 4. Implementation handbook 2012 edition. Rockville, MD: Agency for healthcare research and quality; 2011.

Peschanski N, Barré M, Taboulet P, Joly LM. Validation monocentrique de la classification infirmière des malades aux urgences (CIMU V2). SFMU; 2009. http://nereja.free.fr/files/programme_2010_congres_urgences_ paris_2_4_06_2010.pdf

Cicchetti D, Bronen R, Spencer S, Haut S, Berg A, Oliver P, et al. Rating scales, scales of measurement, issues of reliability: resolving some critical issues for clinicians and researchers. J Nerv Ment Dis 2006; 194:557-64.

Z ou GY. Sample size formulas for estimating intraclass correlation coefficients with precision and assurance. Stat Med 2012; 31:3972-81.

Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas 1973; 33:613-61.