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

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).