Emergency Severity Index Version Research Articles

Emergency Severity Index Version 4 and Triage of Pediatric Emergency Department Patients

Most emergency departments (EDs) across the US use the Emergency Severity Index (ESI) to predict acuity and resource needs. A comprehensive assessment of ESI accuracy among pediatric patients is lacking. To assess the frequency of mistriage using ESI (version 4) among pediatric ED visits using automated measures of mistriage and identify characteristics associated with mistriage. This cohort study used operational measures for each ESI level to classify encounters as undertriaged, overtriaged, or correctly triaged to assess the accuracy of the ESI and identify characteristics of mistriage. Participants were pediatric patients at 21 EDs within Kaiser Permanente Northern California from January 1, 2016, to December 31, 2020. During that time, version 4 of the ESI was in use by these EDs. Visits with missing ESI, incomplete ED time variables, patients transferred from another ED, and those who left against medical advice or without being seen were excluded. Data were analyzed between January 2022 and June 2023. Assigned ESI level. Rates of undertriage and overtriage by assigned ESI level based on mistriage algorithm, patient and visit characteristics associated with undertriage and overtriage. This study included 1 016 816 pediatric ED visits; the mean (SD) age of patients was 7.3 (5.6) years, 479 610 (47.2%) were female, and 537 206 (52.8%) were male. Correct triage occurred in 346 918 visits (34.1%; 95% CI, 34.0%-34.2%), while overtriage and undertriage occurred in 594 485 visits (58.5%; 95% CI, 58.4%-58.6%) and 75 413 visits (7.4%; 95% CI, 7.4%-7.5%), respectively. In adjusted analyses, undertriage was more common among children at least 6 years old compared with those younger 6 years; male patients compared with female patients; patients with Asian, Black, or Hispanic or other races or ethnicities compared with White patients; patients with comorbid illnesses compared with those without; and patients who arrived by ambulance compared with nonambulance patients. This multicenter retrospective study found that mistriage with ESI version 4 was common in pediatric ED visits. There is an opportunity to improve pediatric ED triage, both in early identification of critically ill patients (limit undertriage) and in more accurate identification of low-acuity patients with low resource needs (limit overtriage). Future research should include assessments based on version 5 of the ESI, which was released after this study was completed.

Comparison of Emergency Severity Index Version 4 and Modified Pediatric Early Warning Score as Triage Models in the Pediatric Emergency of a Tertiary Care Public Sector Hospital

Comparison of Emergency Severity Index Version 4 and Modified Pediatric Early Warning Score as Triage Models in the Pediatric Emergency of a Tertiary Care Public Sector Hospital

The effect of computer-based decision support system on emergency department triage: Non-randomised controlled trial

BackgroundDeciding on triage in emergency departments is difficult and requires comprehensive knowledge and experience. PurposeThis study was conducted to evaluate the effect of a “computer-based emergency department triage decision support system (DSS),“ which was designed and integrated into the hospital information management system, on triage decision accuracy and triage duration by using real patient data. MethodsSingle-group, pretest–posttest non-randomised clinical trial. The study was conducted with the real data of patients who had been triaged in the adult emergency department of a university hospital. The pretest was applied between July 16 and September 16, 2019, and the post-test on September 1 and October 31, 2020. In the pre-test and post-test phases of the study, triage decision accuracy rates, and triage duration were evaluated. In the post-test phase, Emergency Triage Decision Support System (ETDSS) was prepared with a rule-based decision trees method using the Emergency Severity Index Version 4 and The Australasian Triage Scale and was integrated into the hospital information management system. The effect of the developed ETDSS was evaluated. The mean, standard deviation, frequency and percentage values were calculated for the descriptive characteristics. Independent samples t-test, analysis of variance, Sidak paired comparison, and Bonferroni tests were applied. ResultsThe effect of the computer-based emergency triage DSS on triage management was tested based on the data of 16,409 patients in the pretest phase and 7,765 patients in the posttest phase. While the accuracy rate of nurses' triage decisions was 57.8% in the pretest, it was found to increase to 64.9% in the posttest. The mean duration of triage was 1.47 ± 0.72 in the pretest and 1.79 ± 0.85 min in the posttest. ConclusionsThe DSS increased triage decision accuracy independently of professional and triage experience and brought the triage duration closer to the time recommended in the literature. Clinically, this is associated with patient safety, quality improvement processes, and professional accountability.

Associated Factors of Under and Over-Triage Based on The Emergency Severity Index; a Retrospective Cross-Sectional Study.

Under-triage increases patients' risks for morbidity and mortality, whereas over-triage limits the resources available to sicker patients. This study aimed to determine the rates as well as associated factors of under-triage and over-triage in emergency department (ED), based on Emergency Severity Index (ESI) triage system. In this retrospective cross-sectional study, triage level of ED patients based on the ESI version 4, was studied during a 9-month period in 2019. Patients' ESI level, which were examined by triage nurses were reevaluated by 3 emergency physicians and the rate of correct, under-, and over-triage as well as their associated factors were analyzed. 1000 cases of triage were evaluated. Triage was correct in 69.1% of cases. The rate of under-triage was 4.9%, and that of over-triage was 26.0%. Over-triage was significantly more common among patients aged 18-30 years than for those aged ≥65 years (adjusted odds ratio [OR] = 1.73; 95% confidence interval [CI]: 1.07-2.81; p = 0.026); those with traumatic injuries (adjusted OR = 1.80; 95% CI: 1.29-2.52; p = 0.001); those arriving at the hospital during the evening shift (adjusted OR = 1.42; 95% CI: 1.01-2.0; p = 0.046); patients who were hospitalized (adjusted OR = 0.35; 95% CI: 0.22-0.54; p < 0.001); and those with severe pain (adjusted OR = 0.28; 95% CI: 0.10-0.84; p = 0.023). Younger age was also significantly associated with under-triage. Patients aged 18-30 years were under-triaged more often than those aged ≥65 years (adjusted OR = 3.05; 95% CI: 1.16-8.00; p = 0.023). Over-triage was substantially more common than under-triage in Vajira Hospital. Factors associated with over-triage were younger age, traumatic injury, arrival time, hospital admission, and severe pain. Younger age was the only factor related to under-triage.

Pediatric emergency triage systems.

ABSTRACTObjective:The aim of this study was to perform a narrative review of the leading pediatric triage systems in emergency departments (EDs).Data source:Articles published between 1999 and 2019 were identified by searching the MEDLINE, EMBASE, and PubMed databases using the keywords “pediatric triage”, “pediatric assessment tools”, and “emergency department triage” with an emphasis on studies that evaluated the validation and reliability of triage systems.Data synthesis:A total of 105 articles on pediatric emergency triage systems in 12 countries were evaluated. Triage systems were divided into two groups: color-stratified triage systems and alert systems. The color-stratified triage systems included in this review were the Canadian Triage and Acuity Scale (CTAS), Manchester Triage System (MTS), Emergency Severity Index (ESI), and Australasian Triage Scale (ATS), and the alert systems included were the Paediatric Observation Priority Score (POPS), Pediatric Early Warning Score (PEWS), and Pediatric Approach Triangle (PAT). Evidence corroborates the validity and reliability of MTS, PaedCTAS, ESI version 4, PEWS, POPS, and PAT in pediatric emergency services.Conclusions:These are fundamental tools for risk classification of patients seeking treatment in EDs. Not all triage systems have been assessed for validity and reliability; nor are they well suited for all regions of the world. Employing triage systems in Brazil requires cultural adaptation and rigorous training of the local health staff, in addition to validation and reliability studies in our country, since the social and cultural context of this country differs from those where these tools were developed.

Evaluation of the Emergency Severity Index (Version 4) in Postpartum Women after Cesarean Delivery.

The Emergency Severity Index (ESI) version 4 is a 5-level triage system (1 being the highest acuity and 5 being the lowest acuity) used in the emergency department (ED). Our goal of the study was to compare rates of readmission according to ESI in postpartum women. This was a secondary analysis of a retrospective cohort study of all women who presented to the ED within 6 weeks after cesarean delivery. The acuity level was assigned by triage nurses at the time of triage presentation. Our primary outcome was postpartum readmission. To examine if the addition of blood pressure to vital sign abnormalities would improve the prediction for readmission, we created a modified ESI. We identified women who had an ESI of level 3 and reassigned to a modified ESI of level 2 if blood pressure was in the severe range. Receiver operating characteristic curves with area under the curve (AUC) were created and compared between ESI and modified ESI. Of 439 women, ESI distribution was 0.2% ESI 1, 23.7% ESI 2, 56.0% ESI 3, 19.4% ESI 4, and 0.7% ESI 5. Readmission rates by ESI level were 100% ESI 1, 47% ESI 2, 18% ESI 3, 2% ESI 4, and 0% ESI 5 (p < 0.001). Of 246 women who were assigned an ESI of 3, total 25 had severe range blood pressures and were reassigned to a modified ESI of 2. Of these 25 women, 14 were readmitted. The AUC of the modified ESI was statistically higher than that of the standard ESI (AUC: 0.77 and 95% confidence interval: 0.72-0.82 vs. AUC: 0.73 and 95% confidence interval: 0.68-0.78; p < 0.01). The ESI was a useful tool to identify women who required postpartum readmission. Incorporation of severe range blood pressure as a parameter of acuity improved the prediction of readmission. · ESI does not consider blood pressure.. · The ESI version 4 was predictive of postpartum readmission.. · Consideration of a severe range blood pressure significantly improved the prediction of readmission..

Validity of the Emergency Severity Index (Version 4) in Postpartum Women After Cesarean Delivery [40P

INTRODUCTION: To examine the validity of the Emergency Severity Index version 4 (ESI v.4) in women who presented to an Emergency Department within 6 weeks after cesarean delivery. METHODS: This was a retrospective cohort study of all women who presented to MedStar Washington Hospital Center Emergency Department from July 2013 to June 2018 within 6 weeks after cesarean delivery. Acuity level was assigned by triage nurses using the ESI v.4 algorithm (1 being the highest acuity and 5 being the lowest acuity). To analyze the validity of ESI v.4, women were divided into 3 groups: high-acuity (ESI levels 1 and 2), medium-acuity (ESI level 3), and low-acuity (ESI levels 4 and 5). We examined the rates of readmission, specialty consultations such as gynecologists, and high resource use (2 or more). RESULTS: Of 439 women who presented to the Emergency Department, the distribution of acuity levels was as follows: low-acuity 20.1%; medium-acuity 56.0%; and high-acuity 23.9%. High-acuity and medium-acuity groups had higher rates of hospital admission compared to low-acuity group (2.3% vs. 19.1% vs. 47.6%; P&lt;.001). High-acuity and medium-acuity groups had higher rates of specialty consultation compared to low-acuity group (12.5% vs. 47.2% vs. 69.5%; P&lt;.001). High-acuity and medium-acuity groups had higher rates of high resource use compared to low-acuity group (15.5% vs. 70.8% vs. 86.0%; P&lt;.001). CONCLUSION: The ESI v.4 was predictive of readmission, specialty consultation, and high resource use in women who presented to the Emergency Department within 6 weeks after cesarean delivery.

Validity and Reliability of the Emergency Severity Index and Australasian Triage System in Pediatric Emergency Care of MofidChildren'sHospital in Iran.

Objective:To evaluate the validity, reliability, sensitivity, and specificity of the Emergency Severity Index (ESI) and Australasian Triage System (ATS) for children visiting admitted to the emergency department (ED). Methods: This was a prospective study occurred in the Mofid children's Hospital in Iran from August 2017 to November 2018 and children had aged ≤14 years and presented at the ED with a medical symptom were considered eligible for participation. This study was divided into two phases: in the first phase, we determined the inter-rater reliability of ESI version 4 and ATS by triage nurses and pediatric residents. In the second phase, to analyze the validity, sensitivity, and specificity of each triage system. Reliability and agreement rates were measured using kappa statistics. Results:ESI showed inter-rater reliability with kappa of 0.65–0.92 (P<0.001) and ATS showed inter-rater reliability with kappa of 0.51–0.87 ESI had sensitivity ranged from 81% to 95% and specificity ranged from 73% to 86%. In addition, sensitivity ranged of the ATS were 80% to 95% and specificity ranged from 74% to 87%. Under triage and over triage occurred in 12% and 15% of patients respectively in ESI and 13% and 15% of patients respectively in ATS.Conclusion:The ESI and ATS both valid to triage children in the ED section of Mofid children's Hospital paediatric. Reliability of the ESI is good, moderate to good for the ATS.

Artificial Intelligence-Based Triage for Patients with Acute Abdominal Pain in Emergency Department; a Diagnostic Accuracy Study.

Introduction:Artificial intelligence (AI) is the development of computer systems which are capable of doing human intelligence tasks such as decision making and problem solving. AI-based tools have been used for predicting various factors in medicine including risk stratification, diagnosis and choice of treatment. AI can also be of considerable help in emergency departments, especially patients’ triage. Objective:This study was undertaken to evaluate the application of AI in patients presenting with acute abdominal pain to estimate emergency severity index version 4 (ESI-4) score without the estimate of the required resources.Methods:A mixed-model approach was used for predicting the ESI-4 score. Seventy percent of the patient cases were used for training the models and the remaining 30% for testing the accuracy of the models. During the training phase, patients were randomly selected and were given to systems for analysis. The output, which was the level of triage, was compared with the gold standard (emergency medicine physician). During the test phase of the study, another group of randomly selected patients were evaluated by the systems and the results were then compared with the gold standard. Results:Totally, 215 patients who were triaged by the emergency medicine specialist were enrolled in the study. Triage Levels 1 and 5 were omitted due to low number of cases. In triage Level 2, all systems showed fair level of prediction with Neural Network being the highest. In Level 3, all systems again showed fair level of prediction. However, in triage Level 4, decision tree was the only system with fair prediction. Conclusion:The application of AI in triage of patients with acute abdominal pain resulted in a model with acceptable level of accuracy. The model works with optimized number of input variables for quick assessment.

The Utility of Point-of-Care Testing at Emergency Department Triage by Nurses in Simulated Scenarios.

We developed and tested simulated patient scenarios to assess how normal or abnormal point-of-care (POC) test results at triage change prioritization decisions. This was a cross-sectional study where our team developed simulated scenarios and presented them to triage nurses from 3 academic medical centers. Twenty-four scenarios were constructed on the basis of 12 clinical indications from a protocol previously developed by our team. In each scenario, nurses were presented with 2 patients with the same Emergency Severity Index Version 4 (ESI v.4; Agency for Healthcare Research and Quality, Rockville, MD) triage level (Level 2 or Level 3). One of the patients met the inclusion criteria for POC testing under the protocol (cases), whereas the other patient did not (controls). Nurses were asked which of the 2 patients to prioritize first in 3 separate rounds: first without any POC test results, once with abnormal POC test results for case patients, and once with normal POC test results for case patients. Prioritization decisions that changed on the basis of abnormal POC results were defined as "up-triage" and prioritization decisions that changed on the basis of normal results were defined as "down-triage." A total of 39 nurses completed 468 scenarios. In scenarios without any POC test results, 42.3% of case patients were prioritized first. When POC test results were abnormal, 71.6% of cases were prioritized first. When POC test results were normal, 32.7% of case patients were prioritized first. An abnormal POC test resulted in up-triage in 32.5% of the scenarios. When POC test results were normal, there was down-triage in 18.6% of the scenarios. Up- and down-triage rates varied considerably by scenario and clinical indication. Point-of-care testing at emergency department triage results in reasonably high rates of up- and down-triage in simulated scenarios; however, POC tests for specific indications appear to be more useful than others.

Emergency severity index version 4 during the first year of implementation at an academic institution

Background: The Emergency Severity Index (ESI) version 4 (v4) is a triage system based on vital signs, potential limb or organthreat, as well as expected resources needed in the emergency department (ED).Objective: The purpose of this study was to examine accuracy and misclassification rate of ESI triage over one year following implementation.Methods: This was a retrospective analysis of ED encounters from January 2011 to 2012. Charts were selected in one-week intervals every 12 weeks for one year (months 1, 3, 6, 9, and 12). Each encounter was reviewed to determine post hoc ESI level based on care in the ED. Descriptive statistics was used to compare the agreement between initial triage and post hoc ESI levels. Sensitivity and specificity for each level was determined. Kruskal Wallis test (KW) and Mann Whitney U (MWU) was used toassess differences in initial versus post hoc ESI levels by month to explore change in accuracy over time.Results: Five hundred and sixty separate ED encounters were included. Agreement was observed in 301 triage encounters (53.8%). Overestimation of the triage level occurred in 131 (23.4%) encounters, while the triage level was underestimated in 128 (22.9%) encounters. There was a significant decline in accuracy during the year (KW = 10.2; p = .037); with the greatest dropbetween month 1 and 9 months (MWU 4,859; p = .035). Sensitivity ranged from 24% to 76% and specificity ranged from 61% to 99%, based on ESI level.Conclusions: Enhanced education and quality improvement process is necessary to improve overall accuracy rates at this site.

The Emergency Severity Index, version 4, for pediatric triage: a reliability study in Tabriz Children’s Hospital, Tabriz, Iran

BackgroundThe Emergency Severity Index (ESI) has earned reliability and validity in adult populations but has not been adequately evaluated in pediatric patients. The aim of this study was to assess the reliability of the ESI version 4 and inter-rater reliability measures to evaluate the performance of nurses in the emergency ward.MethodsRaters were part of the same team of pediatric emergency medicine team, including pediatric emergency medicine (PEM) physicians and pediatric triage (PT) nurses. Reliability and agreement rates were measured using kappa statistics. The measurements were compared with the admission rates, readmissions to the PEM division, location of admission and death as outcomes.ResultsInitially, PT nurses rated 20 case scenarios. Further in a prospective cohort study, 1104 children were assigned ESI scores by both nurses and physicians. The ratings of case scenarios showed a kappa value of 0.84. In actual patients, ratings showed high concordance with the physicians’ ratings with the kappa value of 0.82 being in a good agreement with the nurses’ ratings. The main area of discordance was detected in level 4 where 48 cases were triaged in higher levels and 25 were triaged in lower levels. The analysis showed the likelihood of admission clearly increased as the ESI score decreased (p<0.0001). There was a significant correlation between the admission status and triage level in both PT nurses’ and PEM physicians’ ratings (Spearman coefficient=0.374, 0.407; p<0.0001).ConclusionESI scores assigned to the pediatric patients are reliable in the hands of experienced PT nurses and PEM physicians. The very good agreement between PT nurses and PEM physicians, demonstrated in this study, is essential in cooperative work in crowded referral emergency departments and helpful in challenging triage cases.

Emergency Severity Index Version 4

The Emergency Severity Index version 4 (ESI v.4) is the most recently implemented 5-level triage system. The validity and reliability of this triage tool in the pediatric population have not been extensively established. The goals of this study were to assess the validity of ESI v.4 in predicting hospital admission, emergency department (ED) length of stay (LOS), and number of resources utilized, as well as its reliability in a prospective cohort of pediatric patients. The first arm of the study was a retrospective chart review of 780 pediatric patients presenting to a pediatric ED to determine the validity of ESI v.4. Abstracted data included acuity level assigned by the triage nurse using ESI v.4 algorithm, disposition (admission vs discharge), LOS, and number of resources utilized in the ED. To analyze the validity of ESI v.4, patients were divided into 2 groups for comparison: higher-acuity patients (ESI levels 1, 2, and 3) and lower-acuity patients (ESI levels 4 and 5). Pearson χ analysis was performed for categorical variables. For continuous variables, we conducted a comparison of means based on parametric distribution of variables. The second arm was a prospective cohort study to determine the interrater reliability of ESI v.4 among and between pediatric triage (PT) nurses and pediatric emergency medicine (PEM) physicians. Three raters (2 PT nurses and 1 PEM physician) independently assigned triage scores to 100 patients; k and interclass correlation coefficient were calculated among PT nurses and between the primary PT nurses and physicians. In the validity arm, the distribution of ESI score levels among the 780 cases are as follows: ESI 1: 2 (0.25%); ESI 2: 73 (9.4%); ESI 3: 289 (37%); ESI 4: 251 (32%); and ESI 5: 165 (21%). Hospital admission rates by ESI level were 1: 100%, 2: 42%, 3: 14.9%, 4: 1.2%, and 5: 0.6%. The admission rate of the higher-acuity group (76/364, 21%) was significantly greater than the lower-acuity group (4/415, 0.96%), P < 0.001. The mean ED LOS (in minutes) for the higher-acuity group was 257 (SD, 132) versus 143 (SD, 81) in the lower-acuity group, P < 0.001. The higher-acuity group also had significantly greater use of resources than the lower-acuity group, P < 0.001. The percentage of low-acuity patients receiving no resources was 54%, compared with only 26% in the higher-acuity group. Conversely, a greater percentage of higher-acuity patients utilized 2 or more resources than the lower-acuity cohorts, 43% vs 12%, respectively, P < 0.001. In the prospective reliability arm of the study, 15 PT nurses and 8 PEM attending physicians participated in the study; k among nurses was 0.92 and between the primary triage nurses and physicians was 0.78, P < 0.001. The intraclass correlation coefficient was 0.96 for PT nurses and 0.91 between the primary triage nurse and physicians, P < 0.001. Emergency Severity Index v.4 is a valid predictor of hospital admission, ED LOS, and resource utilization in the pediatric ED population. It is a reliable pediatric triage instrument with high agreement among PT nurses and between PT nurses and PEM physicians.

Factors Influencing Patient Assignment to Level 2 and Level 3 Within the 5-Level ESI Triage System

Prospectively assessing factors that influence triage nurse assignment of patients to the higher risk level 2 compared to the lower risk level 3 has not previously been explored within the 5-level Emergency Severity Index (ESI) triage system. Considering the large amount of information available about the patient, less experienced triage nurses often struggle in deciding what patient information is truly relevant when assessing if a high-risk situation exists. The primary aim of this study was to identify specific factors used by triage nurses to differentiate level 2 patients from level 3 patients. A convenience sample of triage nurses was recruited from 2 ED sites. If at the completion of the nurse-patient triage interaction the nurse assigned the patient to either level 2 or level 3, the triage nurse then completed a questionnaire related to factors that influenced patient assignment. Overall, 18 triage nurses participated in the study with a total of 334 nurse-patient triage interactions collected. Patient age, vital signs, and need for a timely intervention were found to be significant factors that influenced patient assignment to level 2 while expected number of resources influenced patient assignment to level 3. Utilizing experienced triage nurses on average, this study identified specific, objective factors that, combined with factors already delineated in the ESI Version 4 Implementation Manual, have useful implications for less experienced triage nurses by providing a more comprehensive and relevant foundation for data gathering and decision making.

The Emergency Severity Index Version 4

The Emergency Severity Index version 4 (ESI v.4) is a triage system, which demonstrates reliability in adult populations, however, it has not been extensively studied in pediatrics. The goal of this study was to measure interrater reliability and agreement rates within and between a group of pediatric emergency medicine physicians and pediatric triage (PT) nurses using ESI v.4 in a pediatric population. Pediatric emergency medicine physicians and PT nurses completed ESI v.4 training and a survey of 20 pediatric case scenarios, requiring them to assign a triage category to each case. Cases and standardized responses were adapted from the ESI v.4 training materials. Unweighted and weighted kappa was measured, and agreement rates for each group were compared with the standard response. Sixteen physicians and 17 nurses completed the study. The group had a mean of 10.2 (+/-7.7) years experience in pediatrics. Nurses had a mean of 7.6 (+/-8.7) years experience in triage. Unweighted kappa for physicians and nurses was 0.68 and 0.67, respectively. Weighted kappa for physicians and nurses was 0.92 and 0.93, respectively. The agreement rate among physicians and nurses with the standardized responses to case scenarios was 83%. ESI v.4 is a reliable tool for triage assessments in pediatric patients when used by experienced pediatric emergency medicine physicians and PT nurses. It is a triage system with high agreement between physicians and nurses.

305: Reliability of Emergency Severity Index Version 4

305: Reliability of Emergency Severity Index Version 4

309: Validation of Modified Emergency Severity Index Version 4

309: Validation of Modified Emergency Severity Index Version 4

The Emergency Severity Index (Version 4): Reliability in Pediatric Patients

Background: The Emergency Severity Index version 4 (ESI v.4) is a triage system that has demonstrated reliability in adult populations, however, it has not been extensively studied in pediatrics. Objective: The goal of this study is to measure the interrater reliability and degree of agreement of the ESI v.4 in the pediatric population between pediatric emergency (PEM) physicians and pediatric triage (PT) nurses. Methods: In this prospective study PEM physicians and PT nurses participated in an ESI v.4 training session.

The Emergency Severity Index (Version 4): Reliability in Pediatric Patients

Objectives: The Emergency Severity Index version 4 (ESI v.4) is a triage system, which demonstrates reliability in adult populations, however, it has not been extensively studied in pediatrics. The goal of this study was to measure interrater reliability and agreement rates within and between a group of pediatric emergency medicine physicians and pediatric triage (PT) nurses using ESI v.4 in a pediatric population. Methods: Pediatric emergency medicine physicians and PT nurses completed ESI v.4 training and a survey of 20 pediatric case scenarios, requiring them to assign a triage category to each case. Cases and standardized responses were adapted from the ESI v.4 training materials. Unweighted and weighted κ was measured, and agreement rates for each group were compared with the standard response. Results: Sixteen physicians and 17 nurses completed the study. The group had a mean of 10.2 (±7.7) years experience in pediatrics. Nurses had a mean of 7.6 (±8.7) years experience in triage. Unweighted κ for physicians and nurses was 0.68 and 0.67, respectively. Weighted κ for physicians and nurses was 0.92 and 0.93, respectively. The agreement rate among physicians and nurses with the standardized responses to case scenarios was 83%. Conclusions: ESI v.4 is a reliable tool for triage assessments in pediatric patients when used by experienced pediatric emergency medicine physicians and PT nurses. It is a triage system with high agreement between physicians and nurses.

Emergency Severity Index Version 4: Clarifying Common Questions

Emergency Severity Index Version 4: Clarifying Common Questions