Year: 2025 | Month: October-December | Volume: 10 | Issue: 4 | Pages: 140-145
DOI: https://doi.org/10.52403/ijshr.20250420
Evaluation of Nurse-Led Triage Accuracy and Factors Associated with Triage Discordance in a Tertiary Care Emergency Department
Dr. Thamminaina Abhinov1, Dr. Suresh S David2, Dr. Abhilash T3, Dr. Chinju Punnen4, Dr. Amal Raja Punnen5, Dr. Shreya6
1Associate Professor, Department of Emergency Medicine, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Karad, India.
2Professor, Department of Emergency Medicine, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Karad, India.
3Department of Critical Care, Aarupadai Veedu Medical College, Vinayaka Mission's University, Puducherry, India.
4Department of Oral & Maxillofacial surgery, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Karad, India.
5Tbilisi State Medical University, Georgia.
6Department of Ophthalmology, Aravind Eye Hospital, Puducherry.
Corresponding Author: Dr. Thamminaina Abhinov
ABSTRACT
Objective: To evaluate the accuracy of nurse-led triage using a three-level institutional protocol in a tertiary care emergency department (ED) and identify predictors of triage discordance.
Methods: This cross-sectional study included 1,249 adult ED patients. Nurse-assigned triage levels were compared with emergency physician (EP) triage, considered the gold standard. Accuracy, under-triage, and over-triage rates were calculated. Cohen's Kappa (κ) assessed agreement. Univariate chi-square (χ²) analysis was performed to identify associations between variables and triage inaccuracy, with odds ratios (OR) and 95% confidence intervals (CI) calculated from cross-tabulations.
Results: Triage accuracy was 94.6%, with 4.88% over-triage and 0.48% under-triage. Agreement between nurse and EP triage was κ = 0.91 (95% CI: 0.89–0.93), indicating excellent concordance. Univariate analysis identified significant associations between over-triage and elevated respiratory rate (≥25/min; p=0.002) and elevated systolic blood pressure (≥160 mmHg; p=0.039). Under-triage was rare (n=6, 0.48%). No variables significantly predicted under-triage.
Conclusion: Nurse-led triage demonstrated high accuracy and excellent agreement with emergency physicians. Over-triage occurred more often than under-triage and was strongly associated with abnormal physiological parameters. Reinforcement of vital-sign interpretation, structured training, and periodic audits may improve further accuracy in resource-limited settings.
Keywords: Triage accuracy; Under-triage; Over-triage; Emergency department; Physiological predictors; Kerala