Accuracy and Reliability of Emergency Department Triage Using the Emergency Severity Index: An International Multicenter Assessment - 23/04/18
Abstract |
Study objective |
We assess accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. In accordance with previous reports and clinical observation, we hypothesize low accuracy and high variability across all sites.
Methods |
This cross-sectional multicenter study enrolled 87 ESI-trained nurses from EDs in Brazil, the United Arab Emirates, and the United States. Standardized triage scenarios published by the Agency for Healthcare Research and Quality (AHRQ) were used. Accuracy was defined by concordance with the AHRQ key and calculated as percentages. Accuracy comparisons were made with one-way ANOVA and paired t test. Interrater reliability was measured with Krippendorff’s α. Subanalyses based on nursing experience and triage scenario type were also performed.
Results |
Mean accuracy pooled across all sites and scenarios was 59.2% (95% confidence interval [CI] 56.4% to 62.0%) and interrater reliability was modest (α=.730; 95% CI .692 to .767). There was no difference in overall accuracy between sites or according to nurse experience. Medium-acuity scenarios were scored with greater accuracy (76.4%; 95% CI 72.6% to 80.3%) than high- or low-acuity cases (44.1%, 95% CI 39.3% to 49.0% and 54%, 95% CI 49.9% to 58.2%), and adult scenarios were scored with greater accuracy than pediatric ones (66.2%, 95% CI 62.9% to 69.7% versus 46.9%, 95% CI 43.4% to 50.3%).
Conclusion |
In this multinational study, concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, our findings point to a need for more reliable ED triage tools.
Le texte complet de cet article est disponible en PDF.Plan
| Please see page 582 for the Editor’s Capsule Summary of this article. |
|
| Supervising editor: Donald M. Yealy, MD |
|
| Author contributions: BM, SSDR, KSB, and JSH conceived and designed the study. BM, SSDR, PSKS, KSB, and XA recruited participants. GK, DM, and KP provided statistical advice on the study design. DM and KP helped analyze the data. SL provided content expertise. BM and JSH drafted the article, and all authors contributed to its revision. JSH takes responsibility for the paper as a whole. |
|
| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
|
| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This work was funded by a Synergy Award from Johns Hopkins University and grant R21HS023641 from the Agency for Healthcare Research and Quality. Dr. Levin is an engineer and the owner of a start-up company that has developed several machine-learning and electronic health record–based tools to improve patient safety and throughput throughout the hospital, including a tool that aims to improve reliability of ED triage. |
|
| The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of Johns Hopkins or the Agency for Healthcare Research and Quality. |
Vol 71 - N° 5
P. 581 - mai 2018 Retour au numéro
Article précédent
- Triage, Machine Learning, Algorithms, and Becoming the Borg
- Stephen M. Schenkel, Robert L. Wears
- Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest
- Takahisa Kawano, Brian Grunau, Frank X. Scheuermeyer, Koichiro Gibo, Christopher B. Fordyce, Steve Lin, Robert Stenstrom, Robert Schlamp, Sandra Jenneson, Jim Christenson
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?