title: Comparison of START triage categories to emergency department triage levels to determine need for urgent care and to predict hospitalization.
abstract: OBJECTIVE
  To compare Emergency Severity Index (ESI) triage levels and Simple Triage and Rapid Treatment (START) triage colors for urgent care and hospitalization.
  
  
  METHODS
  Cross sectional.
  
  
  METHODS
  Inner city emergency department (ED).
  
  
  METHODS
  Patients years transported by Emergency Medical Services (EMS) participating in the state triage tag exercise, October 9-15, 2011.
  
  
  METHODS
  EMS assigned each patient a START triage tag. ED staff recorded tag number and color. Demographics, vital signs, 22 emergent interventions, and disposition were obtained via chart review. Institutional review board approval was obtained.
  
  
  METHODS
  Presence of more than two abnormal vital sign on arrival and need for more than one emergent intervention in ED were considered indicators of acuity and severity. START triage colors were recategorized as urgent (Red, Yellow) and less acute (Green, White), and ESI was recategorized as urgent (1, 2, 3) and less acute (4, 5).
  
  
  RESULTS
  Both ED and EMS staff were blinded to the study, and 95% confidence intervals were presented for statistical significance. Of 233 participants, START triage colors were Black=0, Red=12 percent, Yellow=26 percent, Green=53 percent, and White=9 percent. ESI triage levels were level 1=1 percent, level 2=34 percent, level 3=51 percent, level 4=14 percent, and level 5=1 percent. ESI (1, 2, 3) identified 88 percent (75-95 percent) of 49 patients with abnormal vital signs; START (Red, Yellow) only identified 51 percent (35-64 percent). Twenty-one patients needed emergent intervention. ESI (1, 2, 3) identified 95 percent (76-99 percent) of these patients; START (Red, Yellow) identified 33 percent (17-55 percent). ESI (1, 2, 3) identified 98 percent of the 96(92-100 percent) admitted patients; only 48 percent (38-58 percent) were tagged START (Red, Yellow).
  
  
  CONCLUSIONS
  ESI better identified patients with abnormal vital signs, those who needed emergent interventions, and those admitted than START.
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey.
authors.forename: Rick
authors.initials: R
authors.lastname: Hong
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey.
authors.forename: Ryan
authors.initials: R
authors.lastname: Sexton
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sweet
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey.
authors.forename: Gerard
authors.initials: G
authors.lastname: Carroll
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Tambussi
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey.
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Baumann
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents; D020380:Needs Assessment; D012720:Severity of Illness Index; D014218:Triage / Q000458:organization & administration*