Reliability and Validity of Scores on the Emergency Severity Index Version 3

Abstract

Objectives: No widely used triage instrument accurately assesses patient acuity. The Emergency Severity Index (ESI) promises to facilitate reliable acuity assessment and possibly predict patient disposition. However, reliability and validity of ESI scores have not been established in emergency departments (EDs) outside the original research sites, and version 3 (v.3) of the ESI has not been evaluated. The study hypothesis was that scores on the ESI v.3 show good interrater reliability and predict hospital admission, admission site, and death. Methods: The authors conducted an ED-based cross-sectional retrospective study of 403 systematically selected ED records of patients who presented to an academic medical center. Twenty-seven variables were abstracted, including triage level assigned, admission status, site, and death. Using a standard process, the researchers determined the true triage level. Weighted kappa and Pearson correlation were used to calculate interrater re-

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

“…The ESI is a measure of acuity assigned by a triage nurse prior to physician evaluation, with a range of 1 (high) to 5 (low). Patients with an ESI of 1 are often admitted, 19,20 but comprise only 2 % of admissions from the ED in our study. We excluded them for logistical reasons (low likelihood that they could complete the patient survey given their trauma or critical illness) and in order to target the patient population for which non-medical factors may influence admission decisions.…”

Emergency Department Overcrowding: Analysis of the Factors of Renege Rate

“…During most of the study period, acuity was assessed using the Emergency Severity Index, previously shown to be reliable and valid. 28,29 During the first eight months of our study period, acuity was assessed using the Canadian Triage and Acuity Scale, which has also been shown to be reliable. 30 Chief complaints were also assessed at triage by an RN and were grouped into 53 categories for analysis.…”

Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

“…Additional data extracted from the ED documentation and tracking system included patient age, gender, triage ESI level (1)(2)(3)(4)(5), disposition (admitted, transferred, discharged, LWCE), and admission location (ICU, SDU, Ward).…”

“…Le principal critère d'évaluation était le nombre médian de jours d'hospitalisation, et les critères d'évaluation secondaires consistaient en le nombre médian de jours passés dans un service de soins spécialisés, en la mortalité hospitalière au bout de 30 jours et en la proportion de patients dont l'état avait nécessité un relèvement du niveau de soins durant le séjour à l'hôpital. Résultats: Aucun écart n'a été enregistré entre les groupes en qui concerne le nombre médian de jours d'hospitalisation (3,8 contre [c.] 4,0 jours; p = 0,21) ou le nombre médian de jours passés dans un service de soins spécialisés (5,0 c. 5,6 jours; p = 0,42). Il n'y avait pas de différence non plus quant au pourcentage de la mortalité hospitalière (6,0 % c. 5,6 %; p = 0,66) ou à la fréquence du relèvement du niveau de soins en 24 heures (4,9 % c. 4,0 %; p = 0,52).…”

“…Over the years, a number of ED triage scales have been created, revised, implemented, and studied in attempts to ensure the accuracy of triage categorization. [1][2][3][4][5][6][7] Vital signs are often included in triage assessments and help guide triage classification and resultant timeliness of provider evaluation.…”