Validity of the Revised FRENCH (FRench Emergency Nurses Classification in Hospitals), the Emergency Departments Triage Scale Developed by the French Society of Emergency Medicine

Introduction: In 2016, the French Society of Emergency Medicine had created a triage scale for nurses who welcomed patients on presentation to an emergency department. French Emergency Nurses Classification in Hospitals (FRENCH) ranks priorities from 5 to 1 (from least urgent to most urgent) according to prognosis and complexity/severity of the medical condition. Tri-3, a heterogeneous group in international triage scales, was divided into two levels to distinguish patients who have priority 3A - those who have comorbidity related to the medical condition or who were referred by a physician, from the other patients (3B). Objective: Assess the validity of the six-level FRENCH triage scale. Methods: We have analyzed the demographic data, vital parameters, prescribed complementary tests, and duration of care for all consecutive patients admitted in a university hospital over a period of nine months. We used as criteria of validity, the relations between the triage levels and the rate of hospitalization on one hand and the number of prescribed complementary tests (electrocardiogram, radiology, specialist consultation, biology) on the other hand. Results: The study included 27,598 patients. The distribution of patients by triage level was: 0.4 (level 1), 6.7 (level 2), 13.3 (level 3A), 29.4 (level 3B), 43.1 (level 4), and 7.1% (level 5). The relationship between the triage levels and the hospitalization rate measured by the area under the curve (0.83: 95% confident interval: [0.82-0.83]) was moderate. The correlation between the triage levels and an overall index of prescribed complementary tests was good (K = 0.51), with significant prescription differences between the triage levels (P < 0.001). Conclusion: This study validates the relevance of the six-level FRENCH triage scale by its good ability to classify patients according to their complexity/severity. New assessments might be needed in other emergency departments to confirm its performance and promote its evolution.