First, nurses conducted their triage interviews in the usual manner, i.e. without the use of written protocols or algorithms. The categorization was only done from a brief interview of the patient and included patient complaint(s). Second, as triage nurses, the ED physicians’ categorization was done without the use of written protocols or algorithms. But the categorization was done from clinical examination, medical

record, selleck bio results of diagnostic tests, and from treatment performed in the Inhibitors,research,lifescience,medical ED. This categorization was performed in blind; ED physician raters did not have access to the triage nurses’ notes. For each patient, categorization Inhibitors,research,lifescience,medical was performed in usual conditions without disturbing the activity of ED health professionals. Triage nurses had not attended training session specifically for this study; however categorization of urgency is part of their qualifications [30]. Data analysis Data were analyzed on Spss 16.0 by using proportions or means, and standard deviations of all variables. The main outcome variable was whether the Inhibitors,research,lifescience,medical ED

visit was urgent or not. To evaluate the level of agreement on triage categories between nurses and ED physicians, we calculated the chance-adjusted measure of agreement (Kappa-value) Inhibitors,research,lifescience,medical from 4 × 4 tables. Qualitative descriptions of agreement were as follows: 0.81-1.0 = “almost perfect”, 0.61-0.80 = “substantial”, 0.41-0.60 = “moderate”, 0.21-0.40 = “fair”, 0.0-0.20 = “slight” [31]. Kappa-values

are reported with 95% confidence intervals (CIs). Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of www.selleckchem.com/products/Dasatinib.html accuracy of categorization into urgent and nonurgent case between triage nurses and ED physicians Inhibitors,research,lifescience,medical who were the reference. To assess the discrimination power of this model, a receiver operating characteristic (ROC) curve was constructed. The ROC curve is a graphic method for indicating the trade-off between the true-positive rate (sensitivity) and the false-positive Anacetrapib rate (1 – the specificity) of a test or diagnostic manoeuvre. Generally, the most discriminating tests have the largest area under the ROC curve, the maximum being 1.0 [32]. Moreover, sensitivity, specificity, PPV and NPV of decision for hospitalization were calculated. For these analyses, ED patients hospitalized at the end of the consultation were compared with patients categorized into urgent or nonurgent cases by triage nurses and by ED physicians. Subgroup analysis Analyses of agreement were performed within subgroups stratified by explicit criteria.