A Comparison of Parental and Nursing Assessments of Level of Illness or Injury in a Pediatric Emergency Department

Abstract

The 5-tier Emergency Severity Index (ESI) score is a well-accepted, validated triage tool with good interrater reliability. Parental perception of illness severity has not been compared to ESI score. This study compares parental assessment of severity of illness to triage nurse acuity. Prospective and descriptive. Large, urban pediatric emergency department (ED). Parents/guardians of patients younger than 18 years. The triage nurse assigned an ESI score, and the parent/ guardian assigned all patients a severity score on a scale of 1 to 5 (1, most sick and 5, least sick). Mean severity scores were compared between the groups. There were 142 participants with a mean patient age of 6.15 years. The mean participant and nurse severity scores were 3.01 and 3.35, respectively, with an intraclass correlation coefficient of 0.203 (P = 0.008). Most frequently, the parent/guardian and triage nurse assigned the same score (n = 44, 31%). Seventy-six percent of the parent/ guardian scores were within 1 point of the triage nurse score. Close agreement exists between parent/guardian and nurse ESI scores, illustrating objectivity in parent/guardian assessments. This study provides a springboard for future studies regarding ED use after educating families on ED triage.