Reliability and Validity of the Australian Mental Health Triage Scale in Children's Hospitals

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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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