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The emergency severity index triage algorithm version 2 is reliable and valid.

David R Eitel1, Debbie A Travers, Alexander M Rosenau

  • 1Department of Emergency Medicine, The York Hospital, Wellspan Health, York, PA 17405, USA. daveitel@cyberia.com

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|October 4, 2003
PubMed
Summary
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The revised Emergency Severity Index (ESI) version 2 tool reliably and validly stratifies patients across multiple emergency departments. This validated triage system aids in identifying patient acuity and resource needs.

Area of Science:

  • Emergency Medicine
  • Healthcare Quality Improvement
  • Clinical Triage Systems

Background:

  • Conventional three-level triage scales have limitations in reliability and validity.
  • The Emergency Severity Index (ESI) was previously shown to be an improvement over traditional scales.
  • The ESI underwent revision to incorporate pediatric criteria and updated vital signs.

Purpose of the Study:

  • To evaluate the reliability and validity of the revised Emergency Severity Index (ESI) version 2.
  • To assess the ESI v.2's performance across multiple diverse emergency department settings.

Main Methods:

  • Interrater reliability was assessed using weighted kappa analysis on written cases and actual patient triages.
  • Validity was determined through a prospective cohort study comparing ESI levels with patient outcomes.

Related Experiment Videos

  • Outcomes analyzed included resource consumption, hospitalization, length of stay, and 60-day mortality.

    • Main Results:

    • Interrater reliability for ESI v.2 ranged from 0.69 to 0.87.
    • Hospitalization rates varied significantly by ESI level (Level 1: 83% to Level 5: 4%).
    • Sixty-day all-cause mortality showed a clear gradient by ESI level (Level 1: 25% to Level 5: 0%).

    Conclusions:

    • ESI version 2 demonstrates reliable and valid patient stratification across seven emergency departments.
    • The ESI v.2 is a robust tool for identifying patient acuity and informing resource allocation.
    • Further evaluation of ESI as a standardized casemix identification system in the US is recommended.