Accuracy of the Emergency Severity Index Triage Instrument for Identifying Elder Emergency Department Patients Receiving an Immediate Life-saving Intervention

Abstract Background Emergency department (ED) triage is important for categorizing and prioritizing patients. Effective triage may assist in crowd reduction in the ED and appropriate patient management. There are several systems, including the 5-level Emergency Severity Index (ESI) and the 4-level Ramathibodi-nurse triage. Currently, there are limited data by which to compare the 5- versus 4-level triage; particularly on health outcomes, such as length of stay in the ED, mortality, and resource needs. Objective To compare the accuracy of 5- and 4-level triage in an ED. Method This observational study was conducted on a cross-section of patients in the ED at Ramathibodi Hospital of Mahidol University, Bangkok, Thailand. Eligible patients were those who visited the ED and were evaluated by ESI and nurse triage. Each evaluation was blinded to the results of the other. Discrimination performance between the 5- and 4-level triage was compared by using the area under a receiver operating characteristic (ROC) curve and concordance statistic for prediction of life saving intervention. Net reclassification improvement (NRI) of the 5-level ESI over the 4-level triage was performed. Result Study criteria were met by 520 patients. The areas under the ROC curves of the ESI and nurse triage on life-saving intervention were 92.2% (95% confidence intervals were 87.3%, 96.9%) and 81.3% (95% CI 75.2%, 87.3%), respectively. Areas under the ROC curve differed significantly (P < 0.001). The overall reclassification improvement was 42.4%. Conclusion The 5-level emergency severity index was more accurate than the 4-level triage in terms of lifesaving intervention.

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Emergency Severity Index Scores Differ by Health Provider’s Gender and Patient’s Age

The Open Anesthesiology Journal ◽

10.2174/1874321801509010017 ◽

2015 ◽

Vol 9 (1) ◽

pp. 17-22 ◽

Cited By ~ 1

Author(s):

Jacob M. Vigil ◽

Joe Alcock ◽

Patrick Coulombe ◽

Chance Strenth

Keyword(s):

Emergency Department ◽

Severity Index ◽

Male Nurses ◽

Treatment Quality ◽

Patient Treatment ◽

Emergency Severity Index ◽

Pain Scores ◽

Emergency Department Nurses ◽

Disparate Treatment ◽

Emergency Department Patients

Background: Experimental research shows that laywomen express higher levels of empathy than men to pain suffering behaviors in others and female practitioners interact with and may prescribe different levels of pain medication to patients than male practitioners. Objectives: In this study we conduct a small medical records review to examine the possibility that female emergency department nurses assign lower levels (i.e., more urgent, serious, resource extensive) of emergency severity index (ESI) scores of patients presenting for care in the emergency department than male nurses, raising the possibility that patients receive disparate treatment during triage depending on the gender of medical staff. Methods: The patient-provided pain scores and the examiner-determined ESI scores of forty-eight male, emergency department patients (21-89yrs, Mage = 57.2, SDage = 19.3) were examined across multiple visits, along with the gender of their triage examiner at each visit of (127 total patient/provider interactions). Results: A cross-classified mixed-effects model to analyze the influence of examiner gender on the triage scores that showed a significant Examiner Gender x Patient Age interaction. Further probing showed that female practitioners ascribed significantly lower ESI scores than male practitioners, although this effect was limited to patients younger than 55 years of age. Conclusion: These findings warrant larger-scale investigations of patient and examiner influences on patient treatment, which are necessary for creating more standardized protocols for reliably assessing emergency-care patients and for reducing health disparities in patient treatment quality.

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Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients With Active Cancer

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2019.05.023 ◽

2019 ◽

Vol 57 (3) ◽

pp. 354-361 ◽

Cited By ~ 5

Author(s):

David Adler ◽

Beau Abar ◽

Danielle D. Durham ◽

Aveh Bastani ◽

Steven L. Bernstein ◽

...

Keyword(s):

Emergency Department ◽

Severity Index ◽

Emergency Severity Index ◽

Emergency Department Patients ◽

Active Cancer

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Different triage categorization using Emergency Severity Index (ESI) method in emergency department

Enfermería Clínica ◽

10.1016/j.enfcli.2018.11.031 ◽

2019 ◽

Vol 29 ◽

pp. 101-104

Author(s):

Mariza Elsi ◽

Iswenti Novera

Keyword(s):

Emergency Department ◽

Severity Index ◽

Emergency Severity Index

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Weight-for-Age Percentile as a Pediatric Predictor of Emergency Department Outcome

Global Pediatric Health ◽

10.1177/2333794x19877037 ◽

2019 ◽

Vol 6 ◽

pp. 2333794X1987703

Author(s):

Vishal Naik ◽

Cheryl Lefaiver ◽

Avni Dervishi ◽

Vinod Havalad

Keyword(s):

Emergency Department ◽

Severity Index ◽

Normal Weight ◽

Independent Effect ◽

Key Factors ◽

Emergency Severity Index ◽

Logistic Regression Models ◽

Younger Age ◽

Ed Visits ◽

Weight For Age

This study is a retrospective cohort study that examines the association between weight-for-age percentile and pediatric admission incidence from the emergency department (ED) for all diagnoses. The charts of 1432 pediatric patients under 18 years with ED visits from 2013 to 2015 at a tertiary children’s hospital were reviewed. Analyses of subject age/weight stratifications were performed, along with ED disposition, reason for visit, and Emergency Severity Index (ESI). Multivariable logistic regression models were used to evaluate the independent effect of weight-for-age percentile on ED disposition while controlling for age, ESI, and reason for visit. Underweight subjects were more likely to be admitted than their normal weight counterparts when analyzed overall (odds ratio [OR] = 2.58, P < .01) and by age: less than 2.0 years of age (OR = 2.04, P = .033), between 2.01 and 6.0 years of age (OR = 8.60, P = .004), and between 6.01 and 13.0 years of age (OR = 3.83, P = .053). Younger age (OR = 0.935, P < .001) and higher acuity (OR = 3.49, P < .001) were also significant predictors of admission. No significant associations were found between weight and likelihood of admission for patients older than 13.01 years or between overweight/obese weight categories and admission for any age subgroups. This study suggests that underweight children younger than 13 years are at higher risk to be admitted from the ED than their normal weight, overweight, and obese counterparts. Even when controlling for other key factors, such as the ESI, a lower weight-for-age percentile was a reliable predictor of hospitalization.

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Validity and reliability of the triage scale in older people in a regional emergency department in Hong Kong

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920971633 ◽

2020 ◽

pp. 102490792097163

Author(s):

Kai Yeung Cheung ◽

Ling Pong Leung

Keyword(s):

Emergency Department ◽

Hong Kong ◽

Confidence Interval ◽

Older People ◽

Expert Panel ◽

Validity And Reliability ◽

Triage Category ◽

Life Saving ◽

Emergency Department Triage ◽

Emergency Department Patients

Background: Older people (⩾65 years) present a unique challenge in emergency department triage. Hong Kong’s Hospital Authority adopts a five-level emergency department triage system, with no special considerations for older people. We evaluated the validity and reliability of this triage scale in older people in a regional Hong Kong emergency department. Methods: In total, 295 cases stratified by triage category were randomly selected for review from November 2016 to January 2017. Validity was established by comparing the real emergency department patients’ triage category against (1) that of an expert panel and (2) the need for life-saving intervention. Triage notes were extracted to make case scenarios to evaluate inter- and intra-rater reliabilities. Emergency department nurses (n = 8) were randomly selected and grouped into <5 and ⩾5 years emergency department experience. All nurses independently rated all 295 scenarios, blinded to clinical outcomes. Results: The percentage agreement between the real emergency department patients’ triage category and the expert panel’s assignment was 68.5%, with 16.3% and 15.3% over-triage and under-triage, respectively. Quadratic weighting kappa for agreement with the expert panel was 0.72 (95% confidence interval: 0.53–0.91). The sensitivity, specificity and positive likelihood ratio for the need for life-saving interventions were 75.0% (95% confidence interval: 47.6%–92.7%), 97.1% (95% confidence interval: 94.4%–98.8%) and 26.2 (95% confidence interval: 12.5%–54.8%), respectively. The Fleiss kappa value for inter-rater reliability was 0.50 (95% confidence interval: 0.47–0.54) for junior and senior nurse groups, respectively. Conclusion: The current triage scale demonstrates reasonable validity and reliability for use in our older people. Considerations highlighting the unique characteristics of older people emergency department presentations are recommended.

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