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Triage Accuracy in Pediatrics Using the Emergency Severity Index
Insights
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.
Introduction:
Although the Emergency Severity Index is the most widely used tool in the United States to prioritize care for patients who seek emergency care, including children, there are significant deficiencies in the tool's performance. Inaccurate triage has been associated with delayed treatment, unnecessary diagnostic testing, and bias in clinical care. We evaluated the accuracy of the Emergency Severity Index to stratify patient priority based on predicted resource utilization in pediatric emergency department patients and identified covariates influencing performance.
Methods:
This cross-sectional, retrospective study used a data platform that links clinical and research data sets from a single freestanding pediatric hospital in the United States. Chi-square analysis was used to describes rates of over- and undertriage. Mixed effects ordinal logistic regression identified associations between Emergency Severity Index categories assigned at triage and key emergency department resources using discrete data elements and natural language processing of text notes.
Results:
We analyzed 304,422 emergency department visits by 153,984 unique individuals in the final analysis; 80% of visits were triaged as lower acuity Emergency Severity Index levels 3 to 5, with the most common level being Emergency Severity Index 4 (43%). Emergency department visits scored Emergency Severity Index levels 3 and 4 were triaged accurately 46% and 38%, respectively. We noted racial differences in overall triage accuracy.
Discussion:
Although the plurality of patients was scored as Emergency Severity Index 4, 50% were mistriaged, and there were disparities based on race indicating Emergency Severity Index mistriages pediatric patients. Further study is needed to elucidate the application of the Emergency Severity Indices in pediatrics using a multicenter emergency department population with diverse clinical and demographic characteristics.
