Observer agreement of the Manchester Triage System and the Emergency Severity Index: a simulation study

M N Storm-Versloot, D T Ubbink, V Chin a Choi, J S K Luitse
Emergency Medicine Journal: EMJ 2009, 26 (8): 556-60

OBJECTIVES: To compare inter and intra-observer agreement of the Manchester Triage System (MTS) and the Emergency Severity Index (ESI).

METHODS: 50 representative emergency department (ED) scenarios derived from actual cases were presented to 18 ED nurses from three different hospitals. Eight of them were familiar with MTS, six with ESI and four were not familiar but trained in both systems. They independently assigned triage scores to each scenario according to the triage system(s) they were familiar with. After 4-6 weeks the same nurses again judged the scenarios in a different order. Unanimity in judgement and unweighted and quadratic-weighted kappas were calculated.

RESULTS: Unanimity in judgement for MTS was 90% and for ESI 73%. One-level disagreement was found in 8% and 23% of the cases, respectively. Interobserver unweighted kappas were 0.76 (95% CI 0.68 to 0.83) for MTS and 0.46 (95% CI 0.37 to 0.55) for ESI. Quadratic-weighted kappas were 0.82 (95% CI 0.74 to 0.89) and 0.73 (95% CI 0.64 to 0.83), respectively. At 4-6 weeks, one-level intra-observer disagreements were 10% and 22% and 2-level disagreement 1% and 2%, respectively. Intra-observer unweighted kappas were 0.84 (95% CI 0.73 to 0.94) for MTS and 0.65 (95% CI 0.59 to 0.72) for ESI.

CONCLUSION: Using paper-based clinical scenarios, MTS was found to have a greater inter and intra-observer agreement than ESI.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"