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Inter-rater agreement of the triagesystem RETTS-HEV


The purpose of this study was to evaluate the inter-rater agreement among nurses using the triage system REETS- HEV (rapid emergency triage and treatment system-hospitalsenheden vest) in a Danish ED.

The use of triage systems in Denmark has recently been implemented together with structural changes in hospital organization .Testing and evaluation is therefore needed. The REETS-HEV is a five scale triage system being used in the Emergency department (ED) of Herning, Denmark since May 2010. The ED is semi-large with 29,000 annual visits.


Consecutive patients presenting to the ED were assessed by both a duty and study nurse using REETS-HEV. Nurses did not receive training prior to the study. 146 patients were enrolled and a blinded, paired and simultaneous triage was conducted independently to evaluate inter-rater agreement using Fleiss kappa.


A total of 155 patients were triaged over a 10 day period and complete data were available for 146 patients. We found the overall agreement to be good (Fleiss kappa 0.60 (0.48; 0.72)). The kappa estimate was higher for the group of patients needing immediate attention (0.83 (0.18;1.47)).


The study demonstrated good inter-rater agreement between two independent observers not receiving any new triage training prior to the study.

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Correspondence to Louise Nissen.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Nissen, L., Kirkegaard, H., Perez, N. et al. Inter-rater agreement of the triagesystem RETTS-HEV. Scand J Trauma Resusc Emerg Med 21 (Suppl 2), A32 (2013).

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