Refining Emergency Severity Index triage criteria.
OBJECTIVE
The Emergency Severity Index (ESI) version 3 is a five-level triage acuity scale with demonstrated reliability and validity. Patients are rated from ESI level 1 (highest acuity) to ESI level 5 (lowest acuity). Clinical experience has demonstrated two levels of ESI level 2 patients: those who require immediate intervention and those who are stable to wait for at least ten minutes. Studies have found that few patients are rated ESI level 1, and it has been suggested that revisions to the ESI might result in appropriate reclassification of some sickest level 2 patients as level 1. The purpose of this study was to identify level 2 patients who might be reclassified as level 1 patients.


METHODS
This was a multisite, prospective study. The authors identified ESI level 2 patients who required immediate, lifesaving intervention and calculated chi-square statistics and odds ratios for variables that predicted which ESI level 2 patients actually received immediate intervention.


RESULTS
Immediate lifesaving interventions were provided for 117 (20.2%) of the 589 patients included in the study. Seventeen predictors of the need for immediate intervention were identified. The strongest predictor was the triage nurse's judgment of the need for immediate intervention, especially airway and medications.


CONCLUSIONS
Specific clinical findings at triage for a subset of ESI level 2 patients were associated with immediate delivery of lifesaving interventions. Revisions to the ESI level 1 criteria may be beneficial.
Tanabe
Paula
P
Department of Emergency Medicine, Institute for Health Services Research and Policy Studies, Northwestern University, Chicago, IL, USA. p-tanabe@northwestern.edu
Travers
Debbie
D
Gilboy
Nicki
N
Rosenau
Alex
A
Sierzega
Gina
G
Rupp
Valerie
V
Martinovich
Zoran
Z
Adams
James G
JG
D016001:Confidence Intervals; D004635:Emergency Medicine / Q000379:methods / Q000706:statistics & numerical data; D016529:Emergency Nursing / Q000295:instrumentation* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014218:Triage / Q000592:standards* / Q000706:statistics & numerical data