Are Pediatric Triage Systems Reliable in the Emergency Department?

BACKGROUND: Few studies have focused on the agreement level of pediatric triage scales (PTSs). The aim of this meta-analytic review was to examine the level of inter-rater reliability of PTSs. METHODS: Detailed searches of a number of electronic databases were performed up to 1 March 2019. Studies that reported sample sizes, reliability coefficients, and a comprehensive description of the assessment of the inter-rater reliability of PTSs were included. The articles were selected according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) taxonomy. Two reviewers were involved in the study selection, quality assessment, and data extraction and performed the review process. The effect size was estimated by z-transformation of reliability coefficients. Data were pooled with random-effects models, and a metaregression analysis was performed based on the method of moments estimator. RESULTS: Thirteen studies were included. The pooled coefficient for the level of agreement was 0.727 (confidence interval (CI) 95%: 0.650–0.790). The level of agreement on PTSs was substantial, with a value of 0.25 (95% CI: 0.202–0.297) for the Australasian Triage Scale (ATS), 0.571 (95% CI: 0.372–0.720) for the Canadian Triage and Acuity Scale (CTAS), 0.810 (95% CI: 0.711–0.877) for the Emergency Severity Index (ESI), and 0.755 (95% CI: 0.522–0.883) for the Manchester Triage System (MTS). CONCLUSIONS: Overall, the reliability of pediatric triage systems was substantial, and this level of agreement should be considered acceptable for triage in the pediatric emergency department. Further studies on the level of agreement of pediatric triage systems are needed.