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The Emergency Severity Index Version 4: reliability in pediatric patients
Yamini Durani1, Deena Brecher, Daniel Walmsley
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Alfred I. duPont Hospital for Children/Thomas Jefferson University, 1600 Rockland Rd, Wilmington, DE 19899, USA. ydurani@nemours.org
Insights
The Emergency Severity Index version 4 (ESI v.4) is a reliable pediatric triage tool. Experienced physicians and nurses showed high agreement when using ESI v.4 for pediatric emergency assessments.
Area of Science:
- Emergency Medicine
- Pediatric Triage
- Healthcare Systems
Background:
- The Emergency Severity Index version 4 (ESI v.4) is a validated triage system for adult populations.
- Limited research exists on its reliability and agreement in pediatric emergency settings.
- Pediatric triage accuracy is crucial for timely and appropriate patient care.
Purpose of the Study:
- To evaluate the interrater reliability and agreement of the ESI v.4 triage system.
- To compare the performance of pediatric emergency medicine physicians and pediatric triage nurses using ESI v.4.
- To assess the applicability of ESI v.4 in a pediatric patient population.
Main Methods:
- Physicians and nurses received ESI v.4 training.
- Participants assessed 20 standardized pediatric case scenarios.
- Interrater reliability was measured using unweighted and weighted kappa statistics.
- Agreement rates were compared against established standardized responses.
Main Results:
- Sixteen physicians and 17 nurses participated, with extensive experience in pediatrics and triage.
- Unweighted kappa values were 0.68 for physicians and 0.67 for nurses.
- Weighted kappa values were high: 0.92 for physicians and 0.93 for nurses.
- An overall agreement rate of 83% was observed between participants and standardized responses.
Conclusions:
- The ESI v.4 demonstrates high reliability and agreement for triage assessments in pediatric patients.
- Experienced pediatric emergency physicians and triage nurses can effectively utilize the ESI v.4.
- The ESI v.4 is a dependable tool for pediatric emergency triage, fostering consistency between healthcare professionals.
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 kappa 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 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%.
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.