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Assessing triage nurses and emergency physicians on their interpretation of the C-3PO rule

A study has found almost perfect interrater reliability between triage nurses and emergency physicians in interpreting the C-3PO rule when evaluating children with head trauma.

A study has found almost perfect interrater reliability between triage nurses and emergency doctors in interpreting the C-3PO rule when evaluating children who present at an emergency department (ED) for head trauma.

Child_Head_Injury
Picture: Alamy

The C-3PO rule is used to identify children at risk of skull fracture and this was a prospective observational study performed in a consecutive sample of children visiting a single ED.

A total of 226 paediatric patients were evaluated by a physician and a nurse. The children were all younger than 24 months and had sustained head trauma within the previous 24 hours.

Each of the 34 nurses and 42 physicians in the study evaluated up to 21 children. The primary outcome measure was whether they agreed on which patients were at high risk of skull fracture based on their interpretation of the C-3PO rule.

The results showed that interrater reliability, measured by kappa score, was excellent, and the ten children who had sustained a fractured skull were identified as high risk by the nurse and the doctor. The evaluation outcome was kept blinded between nurse and physician.

The researchers, based at the University of Montreal, Canada, say that the C-3PO rule has been validated for use by emergency doctors but, based on their study, triage nurses could also apply the rule to identify children under two who are at risk of skull fracture.

They suggest that this could help to improve patient flow in the emergency setting.

 


 

Gravel J, Gouin S, Canuel A et al (2017) Reliability of triage nurses and emergency physicians for the interpretation of the C-3PO rule for head trauma in children. Journal of Emergency Nursing. doi: 10.1016/j.jen.2017.06.013 [Epub ahead of print]

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