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A study on reliability of a new triage emergency method among nursing students


We analysed triage reliability among nursing students at an Italian university before and after a course on a new Triage Emergency Method, TEM v2, which showed good reliability in a previous study [1]. Few studies compared triage reliability in nursing students. To our knowledge there are no Italian studies on this topic.


This is an observational study conducted in the University of Parma using a triage scenarios database used in previous studies [1, 2]. Fifty students attending the third year of a nursing course were selected to assign a triage level to 105 paper scenarios, without triage protocols (before course) and with TEMv2 (1 month after a 2-hour course on triage and TEMv2). To prevent communication between participants, they assigned triage codes in different rooms, and in the presence of two investigators. The triage scenarios were given randomly to the participants. We measured: the inter-reliability using the weighted kappa statistics; the complete disagreement (when nurses of the same group assigned to the same scenario triage codes that differed in more than two priority levels); the complete agreement (when all five nurses assigned the same triage code) before and after the course.


Of the 105 patients included in triage scenarios, 66 (63%) were women, the mean age was 43.7 years (SD ± 26.3), and 22 were under the age of 18 years. The most frequent presentation at triage was minor trauma (30%). There were 30 hospital admissions: 27 in non-intensive wards and three in ICUs. The mean age of students was 24 ± 3 SD. Few participants attended triage training before (18%) and they declared scarce triage knowledge. Inter-rater reliability was k = 0.42 (95% CI: 0.37 to 0.46) and k = 0.61 (95% CI: 0.56 to 0.67) before the course (without triage protocol) and after the course (with TEMv2), respectively. Complete disagreement occurred in 98% of scenarios evaluated before and in 64% after the course. Complete agreement was always zero.


Our data suggest that TEM v2 improves triage reliability among nursing students. It seems to be easy to understand and to use.


  1. 1.

    Parenti N, et al.: Reliability and validity of two four-level emergency triage systems. Eur J Emerg Med 2009, 16: 115-120. 10.1097/MEJ.0b013e328310b594

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  2. 2.

    Parenti N, et al.: Affidabilità e validità di un Metodo di Triage di Pronto Soccorso a 4 codici di priorità. Emerg Care J 2008, 5: 30-33.

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Parenti, N., Sangiorgi, D., Serventi, V. et al. A study on reliability of a new triage emergency method among nursing students. Crit Care 14, P279 (2010).

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  • Complete Agreement
  • Nursing Student
  • Triage Protocol
  • Weighted Kappa
  • Priority Level