title: Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention.
abstract: OBJECTIVE
  The study objective was to determine the sensitivity and specificity of the Emergency Severity Index (ESI) triage instrument for the identification of elder patients receiving an immediate life-saving intervention in the emergency department (ED).
  
  
  METHODS
  The authors reviewed medical records for consecutive patients 65 years or older who presented to a single academic ED serving a large community of elders during a 1-month period. ESI triage scores were compared to actual ED course with attention to the occurrence of an immediate life-saving intervention. The sensitivity and specificity of an ESI triage level of 1 for the identification of patients receiving an immediate intervention was calculated. For 50 cases, the triage nurse ESI designation was compared to the triage level determined by an expert triage nurse based on retrospective record review.
  
  
  RESULTS
  Of 782 consecutive patients 65 years or older who presented to the ED, 18 (2%) had an ESI level of 1, 176 (23%) had an ESI level of 2, 461 (60%) had an ESI level of 3, 100 (13%) had an ESI level of 4, and 18 (2%) had an ESI level of 5. Twenty-six patients received an immediate life-saving intervention. ESI triage scores for these 26 individuals were as follows: ESI 1, 11 patients; ESI 2, nine patients; and ESI 3, six patients. The sensitivity of ESI to identify patients receiving an immediate intervention was 42.3% (95% confidence interval [CI]=23.3% to 61.3%); the specificity was 99.2% (95% CI=98.0% to 99.7%). For 17 of 50 cases in which actual triage nurse and expert nurse ESI levels disagreed, undertriage by the triage nurses was more common than overtriage (13 vs. 4 patients).
  
  
  CONCLUSIONS
  The ESI triage instrument identified fewer than half of elder patients receiving an immediate life-saving intervention. Failure to follow established ESI guidelines in the triage of elder patients may contribute to apparent undertriage.
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA. tplattsm@med.unc.edu
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Platts-Mills
authors.forename: Debbie
authors.initials: D
authors.lastname: Travers
authors.forename: Kevin
authors.initials: K
authors.lastname: Biese
authors.forename: Brenda
authors.initials: B
authors.lastname: McCall
authors.forename: Steve
authors.initials: S
authors.lastname: Kizer
authors.forename: Michael
authors.initials: M
authors.lastname: LaMantia
authors.forename: Jan
authors.initials: J
authors.lastname: Busby-Whitehead
authors.forename: Charles B
authors.initials: CB
authors.lastname: Cairns
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D004635:Emergency Medicine / Q000379:methods* / Q000592:standards; D016529:Emergency Nursing / Q000379:methods; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods* / Q000451:nursing / Q000592:standards; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009730:Nursing Assessment / Q000379:methods; D015403:Nursing Evaluation Research; D015588:Observer Variation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method; D014193:Trauma Centers; D014218:Triage / Q000379:methods* / Q000592:standards