Triage with the French Emergency Nurses Classification in Hospital scale: reliability and validity

TLDR

The French Emergency Nurses Classification in Hospital (FRENCH) scale, first French triage tool for ED patients, was modified in 2006 to include roughly 100 determinants and triage adults into five severity levels. The study evaluated FRENCH v.2 in our emergency department. Reliability was assessed on 300 prospectively selected records and validity on 941 patients over 14 days, using blinded nurse pairs to independently triage 100 patients and measuring interrater reliability with weighted kappa. Reliability was good (K = 0.77), and validity was demonstrated by a distribution of 941 patients across five triage levels, a strong negative correlation between resource consumption and severity (R = –0.643, P < 0.0001), and an AUC of 0.858 for predicting admission.

Abstract

The FRench Emergency Nurses Classification in Hospital scale (FRENCH) is the first French triage tool for patients visiting an emergency department. The FRENCH scale modified in 2006, based on about 100 determinants (complaints, signs, and vital parameters), allows the triage of adult patients according to five increasing levels of complexity/severity. We evaluated FRENCH version 2 (v.2) in our emergency department.Reliability was evaluated on 300 prospectively selected patient records (50% of patients admitted). Three nurse pairs, blinded with respect to the original triage, retrospectively and independently triaged 100 patients. Interrater reliability within the pairs was measured with a weighted kappa. Validity was evaluated on all triaged patients (N=941) over 14 days by studying the relationships between the original triage category assigned by the triage nurse and resource consumption and the admission rate.Interrater reliability was good [K=0.77 (95% confidence interval: 0.71-0.82)]. Distribution of the 941 patients included in the validation study (18% of whom were admitted) was as follows [n (%)]: 2 (0.2), 33 (4), 258 (27), 451 (48), and 197 (21) for a triage from 1 to 5, respectively. Resource consumption correlated well with case severity as assessed by the triage category (R=-0.643, P<0.0001). Finally, the area under the receiver operating characteristic curve for prediction of admission as a function of triage was 0.858 (95% confidence interval: 0.831-0.885).FRENCH v.2 is a reliable and validated triage tool to predict the complexity/severity of a patient in our emergency department.