title: A Web-Based Tool for Patient Triage in Emergency Department Settings: Validation Using the Emergency Severity Index.
abstract: BACKGROUND
  We evaluated the concordance between triage scores generated by a novel Internet clinical decision support tool, Clinical GPS (cGPS) (Lumiata Inc, San Mateo, CA), and the Emergency Severity Index (ESI), a well-established and clinically validated patient severity scale in use today. Although the ESI and cGPS use different underlying algorithms to calculate patient severity, both utilize a five-point integer scale with level 1 representing the highest severity.
  
  
  OBJECTIVE
  The objective of this study was to compare cGPS results with an established gold standard in emergency triage.
  
  
  METHODS
  We conducted a blinded trial comparing triage scores from the ESI: A Triage Tool for Emergency Department Care, Version 4, Implementation Handbook to those generated by cGPS from the text of 73 sample case vignettes. A weighted, quadratic kappa statistic was used to assess agreement between cGPS derived severity scores and those published in the ESI handbook for all 73 cases. Weighted kappa concordance was defined a priori as almost perfect (kappa > 0.8), substantial (0.6 < kappa < 0.8), moderate (0.4 < kappa < 0.6), fair (0.2 < kappa< 0.4), or slight (kappa < 0.2).
  
  
  RESULTS
  Of the 73 case vignettes, the cGPS severity score matched the ESI handbook score in 95% of cases (69/73 cases), in addition, the weighted, quadratic kappa statistic showed almost perfect agreement (kappa = 0.93, 95% CI 0.854-0.996). In the subanalysis of 41 case vignettes assigned ESI scores of level 1 or 2, the cGPS and ESI severity scores matched in 95% of cases (39/41 cases).
  
  
  CONCLUSIONS
  These results indicate that the cGPS is a reliable indicator of triage severity, based on its comparison to a standardized index, the ESI. Future studies are needed to determine whether the cGPS can accurately assess the triage of patients in real clinical environments.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States. pierre.elias@duke.edu.
authors.forename: Pierre
authors.identifier: http://orcid.org/0000-0002-9643-3024
authors.initials: P
authors.lastname: Elias
authors.forename: Ash
authors.identifier: http://orcid.org/0000-0002-8558-3625
authors.initials: A
authors.lastname: Damle
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0001-8866-5389
authors.initials: M
authors.lastname: Casale
authors.forename: Kim
authors.identifier: http://orcid.org/0000-0002-5326-8911
authors.initials: K
authors.lastname: Branson
authors.forename: Chaitanya
authors.identifier: http://orcid.org/0000-0002-6022-5856
authors.initials: C
authors.lastname: Churi
authors.forename: Ravi
authors.identifier: http://orcid.org/0000-0003-2217-2834
authors.initials: R
authors.lastname: Komatireddy
authors.forename: Jamison
authors.identifier: http://orcid.org/0000-0002-8769-1574
authors.initials: J
authors.lastname: Feramisco
keywords: clinical decision support; differential diagnosis; emergency severity index; triage