Inter-rater reliability of the Korean Triage and Acuity Scale performed between the prehospital and hospital stages

Abstract

Objective: In Korea, patient evaluation faces limitations because of the differences in the triage system between the prehospital and hospital stages. To solve this problem, the Korean Triage and Acuity Scale (KTAS), a severity classification tool used in hospitals, is also used at the prehospital stage. Prehospital KTAS (pre-KTAS) is a new triage method used at this stage. However, there are few studies on the degree of agreement between prehospital and hospital evaluations. Therefore, we sought to evaluate the agreement between the pre-KTAS and KTAS triage.

Method: We conducted a retrospective observational study of patients who visited the emergency department at Keimyung University Dongsan Hospital via emergency medical services from November to December 2023. We compared the agreement between the pre-KTAS and KTAS triage and examined the differences according to certain subgroups.

Results: Triage was performed on 503 patients, and a moderate agreement was observed between the pre-KTAS and KTAS triage results (weighted kappa, 0.572; 95% confidence interval [CI], 0.513-0.632; P<0.001). The agreement rate tended to be higher in patients with the same main symptoms (weighted kappa, 0.601; 95% CI, 0.537-0.666) or apparent symptoms such as fever (weighted kappa, 0.690; 95% CI, 0.590-0.791) and change of consciousness (weighted kappa, 0.627; 95% CI, 0.412-0.843).

Conclusion: The agreement between the pre-KTAS and KTAS triage results appears to be moderate. The agreement is higher when there is an objective finding or matching of the main symptoms.