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Triage Accuracy in Pediatrics Using the Emergency Severity Index.

Warren D Frankenberger, Joseph J Zorc, Elizabeth D Ten Have

    Journal of Emergency Nursing
    |December 15, 2023
    PubMed
    Summary

    The Emergency Severity Index (ESI) shows significant inaccuracies in pediatric emergency care, with 50% of children mistriaged, highlighting racial disparities and the need for improved pediatric triage tools.

    Keywords:
    Emergency Severity IndexPediatricsTriage

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    Area of Science:

    • Pediatric Emergency Medicine
    • Healthcare Quality Improvement
    • Triage Systems Evaluation

    Background:

    • The Emergency Severity Index (ESI) is widely used in US emergency departments for patient prioritization.
    • Existing research indicates significant deficiencies in ESI performance, leading to potential adverse outcomes like delayed treatment and biased care.
    • The accuracy of ESI in stratifying pediatric patients requires thorough investigation due to unique developmental and clinical considerations.

    Purpose of the Study:

    • To evaluate the accuracy of the Emergency Severity Index in predicting resource utilization for pediatric emergency department patients.
    • To identify specific patient characteristics and covariates that influence the performance of the ESI in pediatric triage.
    • To assess potential racial disparities in ESI accuracy within a pediatric population.

    Main Methods:

    • A cross-sectional, retrospective study utilizing linked clinical and research data from a single pediatric hospital.
    • Chi-square analysis was employed to determine rates of over- and undertriage.
    • Mixed effects ordinal logistic regression analyzed associations between ESI categories and emergency department resource utilization, incorporating natural language processing of clinical notes.

    Main Results:

    • Analysis included 304,422 pediatric emergency department visits; 80% were assigned lower acuity ESI levels (3-5).
    • Triage accuracy for ESI levels 3 and 4 was low, at 46% and 38% respectively.
    • Significant racial differences in overall triage accuracy were observed, indicating potential bias in the ESI's application to diverse pediatric populations.

    Conclusions:

    • Despite most pediatric patients being assigned ESI levels 3-5, 50% were mistriaged, underscoring ESI's limitations in this demographic.
    • Racial disparities in mistriage rates suggest systemic issues with ESI implementation in pediatric care.
    • Further multicenter research with diverse populations is essential to refine ESI application or develop improved pediatric triage tools.