***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to compare the performance of the Paediatric Canadian Triage and Acuity Scale ( Paed CTAS ) to a previous triage tool with respect to the percentage of admissions , the diagnostic and therapeutic interventions , and the mean pediatric risk of admission ( PRISA ) score in a pediatric tertiary center emergency department . Data were prospect ively collected for 4 months before the Paed CTAS introduction ( PRE group ) and for 4 months after its implementation ( Paed CTAS group ) . Both groups were similar in chief complaints , distribution of triage levels , and mean PRISA score .  In the Paed CTAS group , more patients were triaged in the higher acuity levels ( 53 % vs 36 % , P < .05 ) , but the percentage of admission for these patients was comparatively lower ( 13 % vs 27 % , P<.05 ) . The ability to predict admission was greater for the PRE tool as compared to the Paed CTAS tool ( AUC : 0.82 vs 0.69 , P=.001 ) . The ability to predict requirements for interventions such as blood culture and intravenous fluid bolus was similar for both triage tools OBJECTIVES The objective was to compare the validity of an existing informally structured triage system with the Emergency Severity Index ( ESI ) and the Manchester Triage System ( MTS ) . METHODS A total of 900 patients were prospect ively triaged by six trained triage nurses using the three systems . Triage ratings of 421 ( 48 % ) patients treated only by emergency department ( ED ) physicians were compared with a reference st and ard determined by an expert panel . The percentage of undertriage , the sensitivity , and the specificity for each urgency level were calculated . The relationship between urgency level , re source use , hospitalization , and length of stay ( LOS ) in the 900 triaged patients was determined . RESULTS The percentage of undertriage using the ESI ( 86 of 421 ; 20 % ) was significantly higher than in the MTS ( 48 of 421 ; 11 % ) . When combining urgency levels 4 and 5 , the percentage of undertriage was 8 % for the informally structured system ( ISS ) , 14 % for the ESI , and 11 % for the MTS . In all three systems , sensitivity for all urgency levels was low , but specificity for levels 1 and 2 was high ( > 92 % ) . Sensitivity and specificity were significantly different between ESI and MTS only in urgency level 4 . In all 900 patients triaged , urgency levels across all systems were associated with significantly increased re source use , hospitalization rate , and LOS . CONCLUSIONS All three triage systems appear to be equally valid . Although the ESI showed the highest percentage of undertriage and the ISS the lowest , it seems preferable to use a verifiable , formally structured triage system BACKGROUND / PURPOSE Since the implementation of National Health Insurance in Taiwan , Emergency Department ( ED ) volume has progressively increased , and the current triage system is insufficient and needs modification . This study compared the prioritization and re source utilization differences between the four-level Taiwan Triage System ( TTS ) and the st and ardized five-level Canadian Triage and Acuity Scale ( CTAS )  among ED patients . METHODS This was a prospect i ve observational study . All adult ED patients who presented to three different medical centers during the study period were included . Patients were independently triaged by the duty triage nurse using TTS , and a single trained research nurse using CTAS with a computer support software system .  Hospitalization , length of stay ( LOS ) , and medical re source consumption were analyzed by comparing TTS and CTAS by acuity levels . RESULTS There was significant disparity in patient prioritization between TTS and CTAS among the 1851 enrolled patients . With TTS , 7.8 % , 46.1 % , 45.9 % and 0.2 % were assigned to levels 1 , 2 , 3 , and 4 , respectively . With CTAS , 3.5 % , 24.4 % , 44.3 % , 22.4 % and 5.5 % were assigned to levels 1 , 2 , 3 , 4 , and 5 , respectively . The hospitalization rate , LOS , and medical re source consumption differed significantly between the two triage systems and correlated better with CTAS . CONCLUSION CTAS provided better discrimination for ED patient triage , and also showed greater validity when predicting hospitalization , LOS , and medical re source consumption . An accurate five-level triage scale appeared superior in predicting patient acuity and re source utilization INTRODUCTION The study objectives were to compare reliability and validity of a  3-level ( 3L ) triage system  with a new 5-level ( 5L ) triage system and determine the effect of nursing experience on triage reliability . METHODS The study was conducted in a southeastern tertiary emergency department . With a stratified r and om sample , reliability of 3L triage ratings was measured with weighted kappa ( time 1 ) . The 5L system was then implemented , and weighted kappa was remeasured ( time 2 ) . Validity was assessed by comparing case mix , sensitivity , and specificity at times 1 and 2 , and comparing 5L ratings with physician billing ( Evaluation and Management ) codes and nursing re source intensity at time 2 . RESULTS Time 1 case mix ( 15,324 patients ) was : level 1 , 6 % ; level 2 , 36 % ; level 3 , 59 % , and time 2 ( 16,024 patients ) was : level 1 , 1 % ; level 2 , 8 % ; level 3 , 38 % ; level 4 , 41 % ; level 5 , 13 % . Three hundred-five triage ratings were evaluated from time 1 , and 303 were evaluated from time 2 . Weighted kappa was 0.53 for time 1 and 0.68 for time 2 . Spearman correlations were : 5L and nursing re source intensity , 0.55 ( P < .0001 ) ; and 5L and Em , 0.57 ( P < .0001 ) . Sensitivity was 58 % for the 3L and 68 % for the 5L . Specificity was 83 % for the 3L and 91 % for the 5L . Under-triage rates were 28 % for the 3L and 12 % for the 5L , and less-experienced nurses were more likely to under-triage using the 3L system . DISCUSSION The 5L triage system is safer and provides greater discrimination , better reliability , and improved sensitivity and specificity than the 3L triage system Objective An ideal emergency department ( ED ) triage system accurately prioritises patients on the basis of the urgency of interventions required to avoid under- or over-triage . The objective of this study was to develop and vali date a five-level Taiwan triage and acuity scale ( TTAS ) with an electronic decision support tool . Methods This prospect i ve , multicentre , observational study included 10533 patients triaged at 11 academic medical centres , 18 regional and four district hospitals . Adult patients presenting to the ED were independently triaged by the duty triage nurse in the usual way and trained research nurses using TTAS with a computerised decision support system . Weighted κ statistics were used to assess the reproducibility . Hospitalisation , length of stay , and medical re source consumption were analysed by TTAS acuity levels . Results Most cases were stratified into levels 2 to 3 by the existing four-level triage system , whereas the TTAS stratified most patients to levels 3 ( 41.4 % ) and 4 ( 25.0 % ) , and only a small number to level 1 ( 3.9 % ) ( resuscitation ; most urgent ) . Weighted κ for TTAS assignment was 0.87 ( 95 % CI 0.85 to 0.89 ) . The decrease in mean medical re source consumption and hospitalisation rate was statistically significant with each decrease in the TTAS triage acuity level . The length of stay also decreased significantly as the TTAS level acuity fell from levels 2 to 5 . Conclusions The TTAS was found to be a reliable triage system that accurately prioritises the treatment needed to avoid overtriage , more efficiently deploying the appropriate re sources to ED patients INTRODUCTION Each of the two most commonly used five-level triage tools in North America , the Emergency Severity Index and the Canadian Triage and Acuity Scale have been used as a measure of emergency department re source utilization in addition to acuity . In both cases , it is believed that patients triaged as having a higher level of acuity require a greater number of emergency department re sources . We compared the ability of each tool to predict the emergency department re sources for each emergency department visit and associated hospital admission and in-hospital mortality rates . METHODS This is an observational , cohort study of a population -based r and om sample of patients triaged at two emergency departments over a 4-month period . Correlational analyses were performed to examine the relationship between the triage assessment and : ( i ) re source utilization , ( ii ) hospital admission , and ( iii ) in-hospital mortality . RESULTS From 486 patients , analyses revealed the greatest correlation was between Emergency Severity Index and diagnostic re sources [ -0.54 ( 95 % confidence intervals : -0.58 , -0.50 ) ] and the poorest correlation was between Canadian Triage and Acuity Scale and mortality [ -0.16 ( 95 % confidence intervals : -0.20 , -0.12 ) ] . No statistically significant differences ( P<0.005 ) were observed between each tool 's ability to predict any of the outcomes measured . CONCLUSION No statistically significant difference was observed in the ability of Emergency Severity Index v. 3 and Canadian Triage and Acuity Scale to predict emergency department re source utilization or immediate patient outcomes . This ability is , at best , only moderate indicating that other , more accurate tools than measures of triage acuity are required for this purpose BACKGROUND  Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors . This study aim ed to determine the best triage system in the pediatric emergency department . METHODS This was a prospect i ve observational study . This study was divided into two phases . The first phase determined the inter-rater reliability of five triage systems : Manchester Triage System ( MTS ) , Emergency Severity Index ( ESI ) version 4 , Pediatric Canadian Triage and Acuity Scale ( CTAS ) , Australasian Triage Scale ( ATS ) , and Ramathibodi Triage System ( RTS ) by triage nurses and pediatric residents . In the second phase , to analyze the validity of each triage system , patients were categorized as two groups , i.e. , high acuity patients ( triage level 1 , 2 ) and low acuity patients ( triage level 3 , 4 , and 5 ) . Then we compared the triage acuity with actual admission . RESULTS In phase I , RTS illustrated almost perfect inter-rater reliability with kappa of 1.0 ( P<0.01 ) . ESI and CTAS illustrated good inter-rater reliability with kappa of 0.8 - 0.9 ( P<0.01 ) . Meanwhile , ATS and MTS illustrated moderate to good inter-rater reliability with kappa of 0.5 - 0.7 ( P<0.01 ) . In phase II , we included 1 041 participants with average age of 4.7±4.2 years , of which 55 % were male and 45 % were female . In addition 32 % of the participants had underlying diseases , and 123 ( 11.8 % ) patients were admitted . We found that ESI illustrated the most appropriate predicting ability for admission with sensitivity of 52 % , specificity of 81 % , and AUC 0.78 ( 95%CI 0.74 - 0.81 ) . CONCLUSION RTS illustrated almost perfect inter-rater reliability . Meanwhile , ESI and CTAS illustrated good inter-rater reliability . Finally , ESI illustrated the appropriate validity for triage system Objective To measure and compare the reliability and predictive validity of a four-level triage system ( I-4L ) and the new four-level model triage emergency method ( TEM ) . Methods This observational study was conducted in an urban hospital . Ten nurses were r and omly selected to assign a triage level to 189 paper scenarios , using either the  I-4L model  ( 5 nurses )  or the TEM model  ( 5 nurses ) . We used weighted κ statistics to measure the interrater and intrarater reliability of each triage tool and assessed the validity of each models based on the accuracy in predicting admission . Results Interrater reliability was κ=0.73 [ 95 % CI ( confidence interval ) : 0.59–0.87 ] and κ=0.79 ( 95 % CI : 0.65–0.93 ) with I-4L and TEM , respectively . Intrarater reliability was κ=0.82 ( 95 % CI : 0.67–0.96 ) and κ=0.78 ( 95 % CI : 0.62–0.93 ) , respectively . The accuracy of triage rating for admission prediction was similarly good with I-4L and TEM , namely , 79 % ( 95 % CI : 74–85 ) and 77 % ( 95 % CI : 74–85 ) . The proportion of patients admitted per triage level was similar with the two models . Conclusion The interrater and intrarater reliability for rating triage acuity and for accuracy in patient admission prediction was good with both models . Performance with the new model was similar to that of I-4L despite the nurses ' short experience . The new TEM model has the advantage of 
    Output:
    
Overall , validity of each triage system to identify high and low-urgency patients was moderate to good , but performance was highly variable .
In a subgroup analysis , no clear association was found between ED patient volume or casemix severity of illness and triage systems ' performance .
Established triage systems show a reasonable validity for the triage of patients at the ED , but performance varies considerably .