Reliability and validity of the emergency severity index triage algorithm in a pediatric population

Abstract

Study objectives: As demand for emergency services has continued to outpace available allocated resources in recent years, emergency department (ED) triage systems have faced increasing scrutiny. Longer queues for care make the use of a reliable, valid triage system imperative to patient safety. Little is known about the reliability and validity of triage systems in children. The purpose of this study is to evaluate the reliability and validity of the Emergency Severity Index (ESI) triage algorithm in a pediatric population. Methods: This 2-phase investigation used a methodologic design. In the first phase, interrater reliability was evaluated using ED triage scenarios, as well as in a prospective cohort of ED patients presenting to triage. ED triage nurses and nurse and physician investigators performed retrospective blinded triages using only the original triage note to assess reproducibility. In phase 2, validity was assessed using a retrospective analysis of observed resource use, ED length of stay, and hospitalization compared with resource utilization estimated at triage by the ESI. Results: During the validity phase, 510 patients were included in the final data analysis. Hospitalization, ED length of stay, and resource utilization were strongly associated with ESI category. In the reliability phase, weighted κ for ED nurse triage of standard scenarios ranged from 0.84 to 1.00, representing excellent agreement. Twenty ED pediatric patients were triaged simultaneously by an ED triage nurse and the nurse investigator. Weighted κ was 0.82 (95% confidence interval 0.66 to 0.98), also representing strong agreement between raters. Conclusion: When used to triage pediatric patients, the ESI triage algorithm demonstrated both reliability and validity in this tertiary care pediatric population.