Related Experiment Video
Updated: May 7, 2026
Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
The Emergency Severity Index, version 4, for pediatric triage: a reliability study in Tabriz Children's Hospital,
Amir Hossein Jafari-Rouhi1, Sara Sardashti, Ali Taghizadieh
1Pediatric Health Research Center, Tabriz Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Jafariroohi@yahoo.com.
Insights
The Emergency Severity Index (ESI) is reliable for pediatric triage when used by experienced nurses and physicians. High agreement between pediatric triage nurses and emergency physicians ensures effective patient assessment in busy emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Triage Systems
Background:
- The Emergency Severity Index (ESI) is validated for adults but lacks sufficient evaluation in pediatric populations.
- Assessing the reliability and validity of ESI version 4 in pediatric emergency settings is crucial.
Purpose of the Study:
- To evaluate the reliability and inter-rater agreement of the Emergency Severity Index (ESI) version 4 in pediatric patients.
- To assess the performance of nurses in emergency ward triage using the ESI.
Main Methods:
- A prospective cohort study involving 1104 children was conducted.
- Pediatric triage (PT) nurses and pediatric emergency medicine (PEM) physicians rated ESI scores.
- Kappa statistics were used to measure reliability and agreement, compared against admission rates and outcomes.
Main Results:
- High inter-rater reliability was found, with kappa values of 0.84 for case scenarios and 0.82 for actual patients.
- A strong concordance was observed between PT nurses' and PEM physicians' ESI ratings.
- Lower ESI scores correlated significantly with increased likelihood of admission (p<0.0001).
Conclusions:
- The ESI is a reliable triage tool for pediatric patients when utilized by experienced PT nurses and PEM physicians.
- Excellent agreement between nurses and physicians supports its use in collaborative emergency department environments.
- The ESI aids in managing complex triage cases and improving patient flow in crowded settings.
Background:
The Emergency Severity Index (ESI) has earned reliability and validity in adult populations but has not been adequately evaluated in pediatric patients. The aim of this study was to assess the reliability of the ESI version 4 and inter-rater reliability measures to evaluate the performance of nurses in the emergency ward.
Methods:
Raters were part of the same team of pediatric emergency medicine team, including pediatric emergency medicine (PEM) physicians and pediatric triage (PT) nurses. Reliability and agreement rates were measured using kappa statistics. The measurements were compared with the admission rates, readmissions to the PEM division, location of admission and death as outcomes.
Results:
Initially, PT nurses rated 20 case scenarios. Further in a prospective cohort study, 1104 children were assigned ESI scores by both nurses and physicians. The ratings of case scenarios showed a kappa value of 0.84. In actual patients, ratings showed high concordance with the physicians' ratings with the kappa value of 0.82 being in a good agreement with the nurses' ratings. The main area of discordance was detected in level 4 where 48 cases were triaged in higher levels and 25 were triaged in lower levels. The analysis showed the likelihood of admission clearly increased as the ESI score decreased (p<0.0001). There was a significant correlation between the admission status and triage level in both PT nurses' and PEM physicians' ratings (Spearman coefficient=0.374, 0.407; p<0.0001).
Conclusion:
ESI scores assigned to the pediatric patients are reliable in the hands of experienced PT nurses and PEM physicians. The very good agreement between PT nurses and PEM physicians, demonstrated in this study, is essential in cooperative work in crowded referral emergency departments and helpful in challenging triage cases.