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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 using ESI v.4 for pediatric emergency assessments.
Area of Science:
- Emergency Medicine
- Pediatric Triage 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 settings.
Purpose of the Study:
- To assess 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.
Main Methods:
- Pediatric emergency physicians and nurses underwent ESI v.4 training.
- Participants categorized 20 pediatric case scenarios.
- Interrater reliability was measured using unweighted and weighted Kappa statistics.
Main Results:
- Both physicians (weighted J = 0.92) and nurses (weighted J = 0.93) demonstrated high reliability.
- Overall agreement with standardized responses was 83% among participants.
- Experienced clinicians showed substantial agreement in triage category assignment.
Conclusions:
- The ESI v.4 is a reliable and effective triage tool for pediatric emergency departments.
- High agreement exists between physicians and nurses when utilizing the ESI v.4.
- The ESI v.4 can be confidently applied to pediatric patient triage by experienced 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 J 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 (T7.7) years experience in pediatrics. Nurses had a mean of 7.6 (T8.7) years experience in triage. Unweighted J for physicians and nurses was 0.68 and 0.67, respectively. Weighted J 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.