title: The Emergency Severity Index Version 4: reliability in pediatric patients.
abstract: OBJECTIVE
  The Emergency Severity Index version 4 (ESI v.4) is a triage system, which demonstrates reliability in adult populations, however, it has not been extensively studied in pediatrics. The goal of this study was to measure interrater reliability and agreement rates within and between a group of pediatric emergency medicine physicians and pediatric triage (PT) nurses using ESI v.4 in a pediatric population.
  
  
  METHODS
  Pediatric emergency medicine physicians and PT nurses completed ESI v.4 training and a survey of 20 pediatric case scenarios, requiring them to assign a triage category to each case. Cases and standardized responses were adapted from the ESI v.4 training materials. Unweighted and weighted kappa was measured, and agreement rates for each group were compared with the standard response.
  
  
  RESULTS
  Sixteen physicians and 17 nurses completed the study. The group had a mean of 10.2 (+/-7.7) years experience in pediatrics. Nurses had a mean of 7.6 (+/-8.7) years experience in triage. Unweighted kappa for physicians and nurses was 0.68 and 0.67, respectively. Weighted kappa for physicians and nurses was 0.92 and 0.93, respectively. The agreement rate among physicians and nurses with the standardized responses to case scenarios was 83%.
  
  
  CONCLUSIONS
  ESI v.4 is a reliable tool for triage assessments in pediatric patients when used by experienced pediatric emergency medicine physicians and PT nurses. It is a triage system with high agreement between physicians and nurses.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, Alfred I. duPont Hospital for Children/Thomas Jefferson University, 1600 Rockland Rd, Wilmington, DE 19899, USA. ydurani@nemours.org
authors.forename: Yamini
authors.initials: Y
authors.lastname: Durani
authors.forename: Deena
authors.initials: D
authors.lastname: Brecher
authors.forename: Daniel
authors.initials: D
authors.lastname: Walmsley
authors.forename: Magdy W
authors.initials: MW
authors.lastname: Attia
authors.forename: John M
authors.initials: JM
authors.lastname: Loiselle
mesh_terms: D003625:Data Collection; D004635:Emergency Medicine / Q000193:education; D016529:Emergency Nursing / Q000193:education; D006801:Humans; D009726:Nurses / Q000523:psychology*; D015588:Observer Variation; D010371:Pediatric Nursing / Q000193:education; D010372:Pediatrics / Q000193:education; D010820:Physicians / Q000523:psychology*; D011364:Professional Practice / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D013664:Teaching Materials; D013997:Time Factors; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods* / Q000706:statistics & numerical data