The Emergency Severity Index Version 4: reliability in pediatric patients

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.