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Triage Accuracy in Pediatrics Using the Emergency Severity Index
Journal of Emergency Nursing
|December 15, 2023
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.
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.
