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The Canadian Triage and Acuity Scale (CTAS) has been used not only for determining the priority by which patients are evaluated by physicians but also as a proxy for disease severity, nurse and physician workload, a tool in quality improvement processes, and in funding methodologies.Evaluation of the accuracy and reliability of CTAS performance becomes essential for reliable information.Most studies to validate triage scoring are sophisticated double triage prospective designs, are difficult to apply across systems in real life, contain an intrinsic bias toward better performance, use classroom-based testing methods, do not address one or the other of accuracy or reliability, or do not pave the way for outcome-based decisions.

Similar five-level systems are used in the United States, the United Kingdom, and Australia as well as in other jurisdictions.IR results were compared using raw and quadratic weighted Kappa [4–7] (Quick Calcs by Graph Pad Software Inc. The NR was externally tested for accuracy in the use of the CTAS guidelines using a random case subset and independent review by a Master’s prepared ED nurse educator (RM) with research experience in CTAS Guidelines (both adults and pediatrics) and inter-observer reliability testing.Focus groups chose, by consensus, five Indicator Groups for triage performance review that were felt to represent common and clinically important Chief Complaints (CCs).A second CC permitted either CC to include the patient in a count for the appropriate indicator.A second CC was infrequent; there were no charts with 3 CCs.

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