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Validation of an emergency triage scale for obstetrics and gynaecology: a prospective study.

Validation of an emergency triage scale for obstetrics and gynaecology: a prospective study.
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Veit-Rubin N, Brossard P, Gayet-Ageron A, Montandon CY, Simon J, Irion O, Rutschmann OT, Martinez de Tejada B,


Veit-Rubin N, Brossard P, Gayet-Ageron A, Montandon CY, Simon J, Irion O, Rutschmann OT, Martinez de Tejada B, (click to view)

Veit-Rubin N, Brossard P, Gayet-Ageron A, Montandon CY, Simon J, Irion O, Rutschmann OT, Martinez de Tejada B,

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BJOG : an international journal of obstetrics and gynaecology 2017 03 15() doi 10.1111/1471-0528.14535
Abstract
OBJECTIVE
To evaluate the reliability of a four-level triage scale for obstetrics and gynaecology emergencies and to explore the factors associated with an optimal triage.

DESIGN
Thirty clinical vignettes presenting the most frequent indications for obstetrics and gynaecology emergency consultations were evaluated twice using a computerised simulator.

SETTING
The study was performed at the emergency unit of obstetrics and gynaecology at the Geneva University Hospitals.

SAMPLE
The vignettes were submitted to nurses and midwives.

METHODS
We assessed inter- and intra-rater reliability and agreement using a two-way mixed-effects intra-class correlation (ICC). We also performed a generalised linear mixed model to evaluate factors associated triage correctness.

MAIN OUTCOME MEASURES
Triage acuity.

RESULTS
We obtained a total of 1191 evaluations. Inter-rater reliability was good (ICC 0.748; 95% CI 0.633-0.858) and intra-rater reliability was almost perfect (ICC 0.812; 95% CI 0.726-0.889). We observed a wide variability: the mean number of questions varied from 6.9 to 18.9 across individuals and from 8.4 to 16.9 across vignettes. Triage acuity was underestimated in 12.4% of cases and overestimated in 9.3%. Undertriage occurred less frequently for gynaecology compared with obstetric vignettes [odds ratio (OR) 0.45; 95% CI 0.23-0.91; P = 0.035] and decreased with the number of questions asked (OR 0.94; 95% CI 0.88-0.99; P = 0.047). Certification in obstetrics and gynaecology emergencies was an independent factor for the avoidance of undertriage (OR 0.35; 95% CI 0.17-0.70; P = 0.003).

CONCLUSION
The four-level triage scale is a valid and reliable tool for the integrated emergency management of obstetrics and gynaecology patients.

TWEETABLE ABSTRACT
The Swiss Emergency Triage Scale is a valid and reliable tool for obstetrics and gynaecology emergency triage.

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