Transporting Clinical Tools to New Settings: Cultural Adaptation and Validation of the Emergency Severity Index in German

• Published in: Annals of emergency medicine 2011-03, Vol.57 (3), p.257-264
• Main Authors: Grossmann, Florian F., MNS, RN, Nickel, Christian H., MD, Christ, Michael, MD, Schneider, Kristian, RN, Spirig, Rebecca, PhD, RN, Bingisser, Roland, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Chi-Square Distribution; Culture; Emergencies - classification; Emergency; Emergency and intensive care: techniques, logistics; Emergency Nursing - standards; Female; Germany; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Male; Medical sciences; Middle Aged; Observer Variation; Prospective Studies; Reproducibility of Results; ROC Curve; Severity of Illness Index; Statistics, Nonparametric; Translating; Triage - classification; Triage - standards
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2010.07.021

Study objective To date, no German triage tool with proven reliability and validity exists. The goal of this project is to translate and culturally adapt the Emergency Severity Index (ESI) and to assess reliability and validity of the German version. Methods The ESI was translated following principles recommended for the translation and cultural adaptation of instruments. We performed a prospective, single-center cohort study. Reliability was assessed by calculating Cohen's weighted κ for agreement of 2 experts who reviewed the triage nurses' notes. To assess validity, associations of the number of resources, hospitalization, admission to intensive care, length of stay, and mortality with the assigned ESI level were investigated. Results Only small cultural adaptations had to be made during the translation process. Interrater agreement was high (κw =0.985) in a sample of 125 patients. For the assessment of validity, a sample of 2,114 patients was used. Spearman's rank correlation coefficient between ESI category and number of resources was ρ=−0.567. The association (Kendall's τ) between ESI category and disposition, and hospitalization was τ=−0.429 and τ=−0.453, respectively. The areas under the curves for the predictive ability of the ESI for hospitalization in general and hospitalization to an ICU were 0.788 and 0.856, respectively. The association between emergency department length of stay and ESI category was also significant (Kruskal-Wallis χ2 =450.8; df =4; P