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01.04.2019 | Originalien | Ausgabe 5/2019

Notfall +  Rettungsmedizin 5/2019

Do physicians and nurses agree on triage levels in the emergency department? A meta-analysis

Notfall + Rettungsmedizin > Ausgabe 5/2019
E. Pishbin, M. Ebrahimi, A. Mirhaghi
Wichtige Hinweise
This article is freely accessible via the “Editors Pick” Choice.
You can find a commentary in German on this article written by Professor Dormann and Professor Christ in this issue and digitally at https://​doi.​org/​10.​1007/​s10049-019-0581-5.



Few studies have focused on the agreement between emergency physicians and nurses in the triage of emergency patients. The aim of this meta-analytic review was to examine the level of inter-rater reliability between physicians and nurses on the use of triage scales.


Detailed searches of a number of electronic databases were performed up to 1 September 2018. Studies that reported sample sizes, reliability coefficients, and a comprehensive description of the assessment of the inter-rater reliability of physicians and nurses were included. The articles were selected according to the Guidelines for Reporting Reliability and Agreement Studies (GRRAS). Two reviewers involved in the study selection, quality assessment, and data extraction performed the review process. The effect size was estimated by z-transformation of reliability coefficients. Data were pooled with random-effects models, and a meta-regression was performed based on the method of moments estimator.


Twelve studies were included. The pooled coefficient for the level of agreement between physicians and nurses was substantial, with a value of 0.756 (confidence interval [CI] 95%: 0.659–0.828). The level of agreement was higher for the weighted kappa (κ), live cases, and pediatric cases than the unweighted κ, paper-case scenarios, and adult cases, respectively. The level of agreement between physicians and nurses on triage scales has improved over time (B = 0.011; P < 0.001).


Overall, the level of agreement between physicians and nurses was substantial, and this level of agreement should be considered acceptable for triage in the emergency department. Further studies on the level of agreement between physicians and nurses are needed.

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