Reliability and Validity of the Australian Mental Health Triage Scale in Children's Hospitals.
5 affiliations
- 1Department of Emergency Medicine, University of California, San Francisco, California, USA.
- 2Seattle Children's Research Institute, Seattle, Washington, USA.
- 3Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
- 4Department of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
- 5Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Abstract
Objective
To evaluate interrater reliability and validity of the Australian Mental Health Triage Scale (AMHTS) for children presenting to the emergency department (ED) with behavioral health symptoms.Methods
We conducted a prospective observational study of ED visits by children aged 3-17 with a primary behavioral health symptom at two US children's hospitals. Nurses assigned Emergency Severity Index (ESI) and AMHTS Scores. Interrater reliability was assessed using intraclass correlation coefficients (ICCs) on visits with two independently assigned AMHTS Scores. To evaluate validity, quasi-Poisson regression examined the association of AMHTS Scores and ED resource utilization, adjusted for sociodemographic and clinical factors. Resource use was categorized using the standard ESI definition and an expanded definition incorporating behavioral health-specific resources.Results
We included 454 visits (45.4% aged 10-14, 56.2% female) with at least one AMHTS Score, of which 94.1% were ESI 2 and 26.9% were AMHTS 2. Among 221 visits with two AMHTS Scores, ICC was 0.48 (95% CI 0.37, 0.58). Higher-acuity AMHTS Scores were associated with greater resource utilization. Standard resource use was higher for AMHTS Score 1 (Incidence Rate Ratio [IRR] 1.82, 95% CI 1.12, 2.96) and Score 2 (IRR 1.64, 95% CI 1.15, 2.40) versus AMHTS Score 5. When applying the expanded definition, resource use was higher for AMHTS Score 1-4 versus 5.Conclusion
Interrater reliability of AMHTS was fair, and higher-acuity scores were associated with greater ED resource utilization. AMHTS Scores were more widely distributed than ESI Scores, suggesting a more responsive approach to pediatric behavioral health triage.
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BibTeX
@article{foster2026reliability,
title = {{Reliability and Validity of the Australian Mental Health Triage Scale in Children's Hospitals.}},
author = {Ashley A Foster and Jacqueline Grupp-Phelan and Ryman Crone and Marshall Brown and Kim Denicolo and Kate Farley and Elizabeth R Alpern and Patricia Cobb and Aron Janssen and Jennifer A Hoffmann},
journal = {Academic emergency medicine : official journal of the Society for Academic Emergency Medicine},
year = {2026},
month = oct,
doi = {10.1111/acem.70426},
url = {https://europepmc.org/article/MED/42899685},
note = {CC BY},
}
RIS
TY - JOUR
TI - Reliability and Validity of the Australian Mental Health Triage Scale in Children's Hospitals.
AU - Ashley A Foster
AU - Jacqueline Grupp-Phelan
AU - Ryman Crone
AU - Marshall Brown
AU - Kim Denicolo
AU - Kate Farley
AU - Elizabeth R Alpern
AU - Patricia Cobb
AU - Aron Janssen
AU - Jennifer A Hoffmann
PY - 2026
DA - 2026/10/01
JO - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
DO - 10.1111/acem.70426
UR - https://europepmc.org/article/MED/42899685
AB - Objective To evaluate interrater reliability and validity of the Australian Mental Health Triage Scale (AMHTS) for children presenting to the emergency department (ED) with behavioral health symptoms.Methods We conducted a prospective observational study of ED visits by children aged 3-17 with a primary behavioral health symptom at two US children's hospitals. Nurses assigned Emergency Severity Index (ESI) and AMHTS Scores. Interrater reliability was assessed using intraclass correlation coefficients (ICCs) on visits with two independently assigned AMHTS Scores. To evaluate validity, quasi-Poisson regression examined the association of AMHTS Scores and ED resource utilization, adjusted for sociodemographic and clinical factors. Resource use was categorized using the standard ESI definition and an expanded definition incorporating behavioral health-specific resources.Results We included 454 visits (45.4% aged 10-14, 56.2% female) with at least one AMHTS Score, of which 94.1% were ESI 2 and 26.9% were AMHTS 2. Among 221 visits with two AMHTS Scores, ICC was 0.48 (95% CI 0.37, 0.58). Higher-acuity AMHTS Scores were associated with greater resource utilization. Standard resource use was higher for AMHTS Score 1 (Incidence Rate Ratio [IRR] 1.82, 95% CI 1.12, 2.96) and Score 2 (IRR 1.64, 95% CI 1.15, 2.40) versus AMHTS Score 5. When applying the expanded definition, resource use was higher for AMHTS Score 1-4 versus 5.Conclusion Interrater reliability of AMHTS was fair, and higher-acuity scores were associated with greater ED resource utilization. AMHTS Scores were more widely distributed than ESI Scores, suggesting a more responsive approach to pediatric behavioral health triage.
SN - 1069-6563
SN - 1553-2712
ER -