Clanet R, Aubrion A, Guigne A, Lecadet N, Audigie S, Creveuil Ch, Roupie E, Macrez R. Prospective evaluation of two emergency triage scales: the French Emergency Nurses Classification in Hospitals (FRENCH) and the Emergency Severity Index (ESI). Med Emergency. MJEM 2020; 28:8-12.
Keywords: Accident and Emergency department, Emergency, ESI, FRENCH, Triage
- Authors’ affiliation
- Article history / info
- Conflict of interest statement
Corresponding author: Antoine AUBRION, MD
Emergency medical service (SAMU 14), Caen University Hospital,
14000 Caen, France
Clanet R, MD1,2, Aubrion A , MD 1,3, Guigne A, MD1,4,5, Lecadet N, MD1,2, Audigie S, MD1,4, Creveuil Ch, MD6, Roupie E, MD1,5, Macrez R, MD1,4,5,7
1) Emergency medical service (SAMU 14), Caen University Hospital, Caen, France.
2) Emergency department, Bayeux Hospital, Bayeux, France.
3) Emergency department, Lisieux Hospital, Lisieux, France.
4) Emergency department, Caen University Hospital, Caen, France.
5) Normandy University, medical school, UNICAEN, Caen, France
6) Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France.
7) Normandy University, UNICAEN, INSERM, INSERM UMR-S U1237, Physiopathology and Imaging for Neurological Disorders (PhIND), Cyceron, Caen, France.
Category: original article
Received: Dec. 12, 2018
Revised: Jan. 09, 2019
Accepted: Feb. 13, 2019
There is no conflict of interest to declare
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..