Reliability and validity of a new five-level triage instrument

Area of Science:

• Emergency Medicine
• Healthcare Quality Improvement
• Clinical Triage Research

Background:

• Traditional three-level triage systems in emergency departments (EDs) exhibit limitations in reproducibility and validity.
• Effective patient sorting is crucial for efficient ED operations and patient outcomes.

Purpose of the Study:

• To validate a novel five-level triage instrument, the Emergency Severity Index (ESI), against patient resource utilization and hospitalization.
• To assess the interrater reliability (reproducibility) of the ESI in an emergency department setting.

Main Methods:

• Prospective, observational cohort study involving adult patients in two urban referral hospitals.
• Validation employed resource use and hospitalization as criterion standards.
• Reproducibility was measured using blinded, paired triage assignments and weighted kappa analysis.

Main Results:

• The study enrolled 493 patients, with a median age of 40 years; 32% were hospitalized.
• The Emergency Severity Index demonstrated strong interrater reliability with a weighted kappa of 0.80.
• Triage levels strongly correlated with resource use and hospitalization rates, distinguishing high- from low-acuity patients.

Conclusions:

• The five-level Emergency Severity Index (ESI) is a valid and reliable triage instrument in the studied practice settings.
• The ESI effectively stratifies patients into five distinct levels based on hospitalization and resource intensity.
• This validated instrument enhances the accuracy and consistency of emergency department triage.