9% versus 89.5%, and 43.1% versus 30.9%). Overall, for ED physicians and triage nurses, positive predictive values were low (32.8% versus 27.5%) and negative predictive values were higher (96.6% versus 90.9%)

[Table ​[Table88]. Table 8 Sensitivity, specificity, and predictive value in prediction of hospitalization Discussion Our study shows a Inhibitors,research,lifescience,medical moderate level of agreement between triage nurses and ED physicians in decisions to categorize LY335979 ic50 patients in urgent or nonurgent cases. This finding corroborates the results of the previous studies of Brillman et al., Caterino et al., Frey et al., O’Brien et al., and Lowe et al., who used the same method and also found Inhibitors,research,lifescience,medical poor kappa levels of agreement [35-39]. Kelly et al. are the only ones who found a high level of agreement between nurses and ED physicians (kappa = 0.74), probably because the categorization performed by the nurses and physicians was conducted at the same time (after patients’ discharge from the ED) and was based on chart review [40]. In our study, like in the others, categorization

was performed at two times: upon the entry to the ED by triage nurses, and at the end of visit by ED physicians. Moreover, our data was collected from a representative sample, indeed the socio-demographic and ED visit characteristics were similar Inhibitors,research,lifescience,medical to those reported in the Inhibitors,research,lifescience,medical literature [6,10,29]. Whatever the subgroups stratified by explicit criteria, the level of agreement remained moderate, except for three subgroups of complaint: toxicology, gynecological and cranial injury subgroups. The high levels of agreement for these three subgroups can

be explained by the homogeneneity of case mix. For example, the subgroup of toxicology concerned only two kinds of diagnoses: carbon monoxide poisoning and alcoholism. We also found a low level of agreement for the sub-group of patients older than 75 years. Relative to younger ED patients, elderly patients have a complex mix of medical and Inhibitors,research,lifescience,medical social needs which increases the difficulty to categorize patients into urgent or nonurgent Megestrol Acetate cases. Our study shows a slight level of agreement between triage nurse and ED physicians within the subgroup of hospitalization. This finding corroborates previous studies [34,41] which have shown limitations in using the criterion of hospitalization as an outcome variable to categorize patients into nonurgent cases [2,34,41]. However, this variable is often chosen by authors because it is the only concrete outcome variable recognized as the surrogate indicator of the need for prompt care. The low predictive positive value found in our study corroborates that hospitalization is not a consistent outcome variable to categorize patients into urgent or nonurgent cases.