Reliability analysis of the Manchester Triage System: inter-observer and intra-observer agreement

Souza, Cristiane Chaves de; Chianca, Tânia Couto Machado; Cordeiro Júnior, Welfane; Rausch, Maria do Carmo Paixão; Nascimento, Gabriela Fontoura Lana

doi:10.1590/1518-8345.2205.3005

Acessibilidade / Reportar erro

Brasil

Revista Latino-Americana de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Rev. Latino-Am. Enfermagem 26 • 2018 • https://doi.org/10.1590/1518-8345.2205.3005 copy

Reliability analysis of the Manchester Triage System: inter-observer and intra-observer agreement¹ 1 Paper extracted from Doctoral Dissertation “Análise da confiabilidade do Sistema de Triagem de Manchester para determinar o grau de prioridade de pacientes em serviços de urgência”, presented to Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the reliability of the Manchester Triage System to determine the priority of patients in emergency services.

Method:

This is a reliability study with a sample of 361 nurses. The data were collected in three stages and the questionnaires were applied using the electronic software. The agreement was measured by the evaluation of clinical cases. The outcomes evaluated were agreement with the gold standard and intra-observer in the indication of the flowchart, discriminator, and level of risk. Data were submitted to univariate and bivariate analyses. The agreement was measured by the Kappa index.

Results:

The external and internal reliability of the protocol ranged from moderate to substantial (Kappa: 0.55-0.78). The time of professional experience as a nurse, in emergency services and in the classification of risk were associated with external and internal reliability. The correct choice of the discriminator influenced the correct indication of the risk level (R² = 0.77, p <0.0001) more than the correct choice of the flowchart (R² = 0.16, p <0.0001).

Conclusion:

The reliability of the Manchester Triage System ranged from moderate to substantial and it was influenced by the clinical experience of the nurse. The protocol is safe for defining clinical priorities using different classification flowcharts.

Descriptors:
Nursing; Emergency Medical Services; Triage; Nursing Assessment; Reproducibility of Results; Validity of Tests

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding Author: Cristiane Chaves de Souza Universidade Federal de Viçosa. Departamento de Medicina e Enfermagem Av. Peter Henry Rolfs, s/n Bairro: Campus Universitário CEP: 36570-000, Viçosa, MG, Brasil E-mail:souzac.cris@gmail.com

Variable		n	%
Undergraduate Nursing time
	Less than a year	2	0.55
	Between one and five years	144	39.89
	Between five and ten years	142	39.34
	More than ten years	73	20.22
Highest degree of training obtained or in progress
	Graduation	40	11.08
	Specialization	276	76.46
	Master	33	9.14
	Doctorate degree	12	3.32
Training related to risk classification during graduation
	No content	240	66.48
	Only theoretical content	90	24.93
	Theoretical and practical content	31	8.59
MTS-related training* during undergraduate
	No contente	282	78.12
	Only theoretical content	60	16.62
	Theoretical and practical content with little or no application in clinical practice	16	4.43
	Theoretical and practical content with a lot of application in clinical practice	3	0.83
Time of professional experience as a nurse
	Less than a year	30	8.31
	Between one and five years	164	45.43
	Between five and ten years	96	26.59
	More than ten years	71	19.67
Experience time in emergency services
	Less than a year	82	22.71
	Between one and five years	188	52.08
	Between five and ten years	58	16.07
	More than ten years	33	9.14
Experience time in risk classification as a nurse
	Never	40	11.08
	Less than a year	111	30.75
	Between one and five years	198	54.85
	Between five and ten years	11	3.05
	More than ten years	1	0.27

Variable	Number of correct answers
Variable	Average	Standar deviation	Maximum value	Minimum value
Flowchart	20.60	2.58	27	11
Discriminator	16.40	3.97	26	4
Level of risk	21.72	3.24	28	11

Variable	External Reliability	Internal Reliability
Variable	Kappa: nursesand gold standard	Kappa intra-observer	Kappa: nursesand gold standard
Flowchart	0.72	0.78	0.73
Discriminator	0.55	0.57	0.59
Risk Level	0.69	0.70	0.72

Variable		Categories (Time)	Kappa Index			P-value*
Variable		Categories (Time)	Mean	Standard Deviation	Median
Flowchart Choice	Experience in emergency^‡	Less than 1 year (a^†)	0.70	0.10	0.70	0.04
		Between 1 and 5 years (a^†,b^†)	0.73	0.09	0.74
		Between 5 and 10 years (b^†)	0.74	0,10	0.74
		More than 10 years (a^†,b^†)	0.71	0.08	0.70

Choice of the Discriminator	Experience as a nurse^‡	Less than 1 year (a^†)	0.45	0.15	0.44	<0.001
		Between 1 and 5 years (a^†,b^†)	0.58	0.14	0.62
		Between 5 and 10 years (b^†)	0.56	0.15	0.58
		More than 10 years (a^†,b^†)	0.52	0.13	0.55

	Experience in emergency^‡	Less than 1 year (a^†)	0.48	0.13	0.51	<0.001
		Between 1 and 5 years (a^†,b^†)	0.52	0.17	0.51
		Between 5 and 10 years (b^†)	0.59	0.13	0.59
		More than 10 years (a^†,b^†)	0.60	0.07	0.58

	Experience in risk classification^§	Never (b^†)	0.50	0.12	0.53	<0.001
		Less than 1 year (b^†)	0.55	0.15	0.57
		Between 1 and 5 years (c^†)	0.61	0.12	0.64
		Between 5 and 10 years (c^†)	0.62	0.06	0.60
		More than 10 years (a^†,c^†)	0.40	--	0.32

Variable		Categories (Time)	Kappa Index			P-value*
Variable		Categories (Time)	Mean	Standard Deviation	Median
Flowchart Choice	Experience in risk classification^‡	Never (a^†)	0.73	0.09	0.73	0.001
		Less than 1 year (a^†)	0.75	0.09	0.77
		Between 1 and 5 years (b^†)	0.80	0.09	0.81
		Between 5 and 10 years (a^†,b^†)	0.79	0.06	0.77

Choice of the Discriminator	Experience in emergency^‡	Never (a^†)	0.48	0.14	0.51	0.001
		Less than 1 year (a^†)	0.60	0.14	0.59
		Between 1 and 5 years (b^†)	0.58	0.11	0.55
		Between 5 and 10 years (a^†,b^†)	0.51	0.04	0.51

	Experience in risk classification^‡	Never (a^†)	0.52	0.14	0.53	<0.001
		Less than 1 year (a^†)	0.51	0.12	0.53
		Between 1 and 5 years (b^†)	0.61	0.13	0.62
		Between 5 and 10 years (a^†,b^†)	0.50	0.08	0.47

Choice of risk level	Experience in emergency^‡	Never (a^†)	0.60	0.17	0.59	<0.001
		Less than 1 year (a^†)	0.75	0.14	0.75
		Between 1 and 5 years (b^†)	0.69	0.11	0.70
		Between 5 and 10 years (a^†,b^†)	0.60	0.16	0.64

	Experience in risk classification^‡	Never (a^†)	0.63	0.15	0.65	<0.001
		Less than 1 year (a^†)	0.62	0.15	0.61
		Between 1 and 5 years (b^†)	0.74	0.15	0.76
		Between 5 and 10 years (a^†,b^†)	0.68	0.07	0.66