Pediatric Triage Accuracy in Pediatric and General Emergency Departments.

Abstract

Accurate triage at the time of emergency department (ED) presentation is critical for timely acuity assessment and anticipating resource requirements. Commonly, triage is conducted using the Emergency Severity Index (ESI); however, the accuracy of this approach for children in general EDs is uncertain. The purpose of this study was to quantify pediatric triage accuracy in a national sample of ED visits and evaluate whether presentation to a pediatric vs general ED is associated with mistriage. This was a cross-sectional study of the 2017-2021 National Hospital Ambulatory Medical Care Survey of pediatric (aged <18years) ED visits with an ESI score from 3 to 5. The outcome was mistriage (resource utilization discordant with ESI prediction). Standardized ESI definitions were applied to count resources. We used multivariable logistic regression to evaluate whether presentation to a pediatric or general ED was associated with triage accuracy. Of 149 million visits, mistriage occurred in 53.7% of ESI 3, 57.7% of ESI 4, and 22.9% of ESI 5 visits. Children in general EDs were more likely to be mistriaged than children in pediatric EDs (adjusted odds ratio [OR], 1.29; 95% CI, 1.11-1.50). Young age was associated with mistriage (aged <1year vs aged 13-17: adjusted OR [95% CI], 2.42 [2.00-2.94], 1-5years: 1.79 [1.53-2.10], 6-12years: 1.38 [1.16-1.64]). Mistriage was common among children with an initial ESI of 3 to 5 and more common among children visiting general EDs. Our findings highlight the need for improved resource prediction at the time of triage.