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Pediatric Triage Accuracy in Pediatric and General Emergency Departments
Alexandra T Geanacopoulos1, Alon Peltz2,3, Katherine Melton4
1Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
Insights
Pediatric emergency department (ED) triage accuracy is often low, with mistriage occurring in over half of visits. Children presenting to general EDs and younger children are more likely to be mistriaged, indicating a need for improved triage systems.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Health Services Research
Background:
- Accurate emergency department (ED) triage is crucial for patient acuity assessment and resource allocation.
- The Emergency Severity Index (ESI) is commonly used for triage, but its accuracy in pediatric populations within general EDs is not well-established.
Purpose of the Study:
- To quantify the accuracy of pediatric triage using the ESI in a national sample of ED visits.
- To evaluate if presentation to a pediatric versus a general ED is associated with triage accuracy (mistriage).
Main Methods:
- Cross-sectional study utilizing data from the 2017-2021 National Hospital Ambulatory Medical Care Survey.
- Included pediatric ED visits (age <18 years) with an ESI score of 3 to 5.
- Mistriage was defined as resource utilization discordant with ESI prediction; multivariable logistic regression analyzed associations with ED type and patient age.
Main Results:
- Mistriage was prevalent, occurring in 53.7% of ESI 3, 57.7% of ESI 4, and 22.9% of ESI 5 visits.
- Children in general EDs had a higher likelihood of mistriage compared to those in pediatric EDs (adjusted OR, 1.29).
- Younger children (<1 year, 1-5 years, 6-12 years) were significantly more likely to be mistriaged than older children (13-17 years).
Conclusions:
- Mistriage is common for pediatric patients with ESI scores of 3 to 5.
- Presentation to general EDs increases the risk of mistriage for children.
- Findings underscore the necessity for enhancing resource prediction accuracy during pediatric triage in EDs.
Background And Objectives:
Accurate triage at the time of emergency department (ED) presentation is critical for timely acuity assessment and anticipating resource requirements. Commonly, triage is conducted using the Emergency Severity Index (ESI); however, the accuracy of this approach for children in general EDs is uncertain. The purpose of this study was to quantify pediatric triage accuracy in a national sample of ED visits and evaluate whether presentation to a pediatric vs general ED is associated with mistriage.
Methods:
This was a cross-sectional study of the 2017-2021 National Hospital Ambulatory Medical Care Survey of pediatric (aged <18 years) ED visits with an ESI score from 3 to 5. The outcome was mistriage (resource utilization discordant with ESI prediction). Standardized ESI definitions were applied to count resources. We used multivariable logistic regression to evaluate whether presentation to a pediatric or general ED was associated with triage accuracy.
Results:
Of 149 million visits, mistriage occurred in 53.7% of ESI 3, 57.7% of ESI 4, and 22.9% of ESI 5 visits. Children in general EDs were more likely to be mistriaged than children in pediatric EDs (adjusted odds ratio [OR], 1.29; 95% CI, 1.11-1.50). Young age was associated with mistriage (aged <1 year vs aged 13-17: adjusted OR [95% CI], 2.42 [2.00-2.94], 1-5 years: 1.79 [1.53-2.10], 6-12 years: 1.38 [1.16-1.64]).
Conclusion:
Mistriage was common among children with an initial ESI of 3 to 5 and more common among children visiting general EDs. Our findings highlight the need for improved resource prediction at the time of triage.
