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Limitations in validating emergency department triage scales
  1. Michele Twomey1,
  2. Lee A Wallis2,
  3. Jonathan E Myers3
  1. 1School of Public Health, University of Cape Town, Cape Town, South Africa
  2. 2Division of Emergency Medicine, University of Cape Town & Stellenbosch University, Capetown, South Africa
  3. 3Occupational and Environmental Health Research Unit, University of Cape Town, Capetown, South Africa
  1. Correspondence to:
 Michele Twomey
 School of Public Health, University of Cape Town, Cape Town, South Africa; satriage{at}


Objective: To examine whether current validation methods of emergency department triage scales actually assess the instrument’s validity.

Methods: Optimal methods of emergency department triage scale validation are examined in developed countries and their application to developing countries is considered.

Results and conclusion: Numerous limitations are embedded in the process of validating triage scales. Methods of triage scale validation in developed countries may not be appropriate and repeatable in developing countries. Even in developed countries there are problems in conceptualising validation methods. A new consensus building validation approach has been constructed and recommended for a developing country setting. The Delphi method, a consensual validation process, is advanced as a more appropriate alternative for validating triage scales in developing countries.

  • ATS, Australasian Triage Scale
  • CTAS, Canadian Triage Acuity Scale
  • ED, emergency department
  • ESI, Emergency Severity Index
  • ETAT, Emergency Triage Assessment and Treatment
  • MEWS, Modified Early Warning Score

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  • Funding: None

  • Competing interests: None

  • Contributions: LW had the original idea; MT wrote the first draft; both authors contributed to the final article.