Article Text

Reliability and validity of the Netherlands Triage Standard in emergency care settings: a case scenario study
  1. Marleen Smits,
  2. Erik Plat,
  3. Elleke Alink,
  4. Marieke de Vries,
  5. Maartje Apotheker,
  6. Stef van Overdijk,
  7. Paul Giesen
  1. Scientific Center for Quality of Healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
  1. Correspondence to Dr Marleen Smits, Scientific Center for Quality of Healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands; marleen.smits{at}radboudumc.nl

Abstract

Background The Netherlands Triage Standard (NTS) is a triage system that can be used by different types of emergency care organisations. Our objective was to determine the interrater reliability and construct validity of the NTS when applied to self-presenting patients.

Methods We performed a cross-sectional case scenario study consisting of two parts: (1) paediatric triage in January-February 2019 and (2) adult triage in October-November 2020. In each part, we invited nurse triagists from three general practitioner cooperatives, three ambulance dispatching centres and three hospital emergency departments in the Netherlands to participate. We used 40 case scenarios involving paediatric patients and 41 involving adult patients who could self-present to any emergency care organisation. In advance, an expert panel determined the urgency (six levels) of the case scenarios (reference standard). The main outcome for reliability was the intraclass correlation coefficient (ICC) for urgency level. The main outcomes for validity were degree of agreement with the reference standard, for urgency level, and sensitivity and specificity for high versus low urgency. We used descriptive statistics and logistic multilevel modelling with both case and triagist as random effects.

Results 218 out of 240 invited triagists participated. The ICC among all triagists was 0.73 for paediatric cases and 0.88 for adult cases and was highest in general practitioner cooperatives. For paediatric cases, there was 62.3% agreement with the reference standard about urgency, 17.4% underestimation and 20.2% overestimation. The sensitivity of the NTS for identifying highly urgent paediatric cases was 85.2%; the specificity was 89.7%. For adult cases, there was 68.3% agreement, 13.7% underestimation and 18.0% overestimation. The sensitivity of triage for high urgency in adults was 94.5% and the specificity 83.3%.

Conclusion NTS appears to have good reliability and construct validity for estimating the urgency of health complaints of non-referred patients presenting themselves in emergency care.

  • triage
  • primary health care
  • emergency department

Data availability statement

Data are available on reasonable request. Deidentified participant data are available from the authors on reasonable request (ORCID-ID 0000-0001-9073-5382).

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Data availability statement

Data are available on reasonable request. Deidentified participant data are available from the authors on reasonable request (ORCID-ID 0000-0001-9073-5382).

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Footnotes

  • Handling editor Kirsty Challen

  • Contributors Writing original draft: MS, EA, MdV, MA, SvO. Methodology: MS, EP, PG. Funding acquisition: MS, PG. Investigation: MS, EA, MdV, MA, SvO. Formal analysis and verification of underlying data: MS, EA, MdV, MA, SvO. Data interpretation: MS, EP, EA, MdV, MA, SvO, PG. Guarantor: MS. All authors reviewed and edited the manuscript.

  • Funding This study was funded by Stichting NTS, the Netherlands.

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.