Reliability and Validity of the Emergency Severity Index for Pediatric Triage
Objectives: The Emergency Severity Index (ESI) triage algorithm is a five‐level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all‐age population, but has not...
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| Veröffentlicht in: | Academic emergency medicine 2009-09, Vol.16 (9), p.843-849 |
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| creator | Travers, Debbie A. Waller, Anna E. Katznelson, Jessica Agans, Robert |
| description | Objectives: The Emergency Severity Index (ESI) triage algorithm is a five‐level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all‐age population, but has not been well studied for pediatric triage. This study assessed the reliability and validity of the ESI for pediatric triage at five sites.
Methods: Interrater reliability was measured with weighted kappa for 40 written pediatric case scenarios and 100 actual patient triages at each of five research sites (independently rated by both a triage nurse and a research nurse). Validity was evaluated with a sample of 200 patients per site. The ESI ratings were compared with outcomes, including hospital admission, resource consumption, and ED length of stay.
Results: Interrater reliability was 0.77 (95% confidence interval [CI] = 0.76 to 0.78) for the scenarios (n = 155 nurses) and 0.57 (95% CI = 0.52 to 0.62) for actual patients (n = 498 patients). Inconsistencies in triage were noted for the most acute and least acute patients, as well as those less than 1 year of age and those with medical (rather than trauma) chief complaints. For the validity cohort (n = 1,173 patients), outcomes differed by ESI level, including hospital admission, which went from 83% for Level 1 patients to 0% for Level 5 (chi‐square, p |
| doi_str_mv | 10.1111/j.1553-2712.2009.00494.x |
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Methods: Interrater reliability was measured with weighted kappa for 40 written pediatric case scenarios and 100 actual patient triages at each of five research sites (independently rated by both a triage nurse and a research nurse). Validity was evaluated with a sample of 200 patients per site. The ESI ratings were compared with outcomes, including hospital admission, resource consumption, and ED length of stay.
Results: Interrater reliability was 0.77 (95% confidence interval [CI] = 0.76 to 0.78) for the scenarios (n = 155 nurses) and 0.57 (95% CI = 0.52 to 0.62) for actual patients (n = 498 patients). Inconsistencies in triage were noted for the most acute and least acute patients, as well as those less than 1 year of age and those with medical (rather than trauma) chief complaints. For the validity cohort (n = 1,173 patients), outcomes differed by ESI level, including hospital admission, which went from 83% for Level 1 patients to 0% for Level 5 (chi‐square, p < 0.0001). Nurses from dedicated pediatric EDs were 31% less likely to undertriage patients than nurses in general EDs (odds ratio [OR] = 0.31, 95% CI = 0.14 to 0.67).
Conclusions: Reliability of the ESI for pediatric triage is moderate. The ESI provides a valid stratification of pediatric patients into five distinct groups. We found several areas in which nurses have difficulty triaging pediatric patients consistently. The study results are being used to develop pediatric‐specific ESI educational materials to strengthen reliability and validity for pediatric triage.</description><identifier>ISSN: 1069-6563</identifier><identifier>EISSN: 1553-2712</identifier><identifier>DOI: 10.1111/j.1553-2712.2009.00494.x</identifier><identifier>PMID: 19845551</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Algorithms ; Child ; Documentation ; Emergencies - classification ; Emergency medical care ; Emergency Treatment - methods ; Emergency Treatment - nursing ; Humans ; Nursing Staff, Hospital - standards ; Nursing Staff, Hospital - statistics & numerical data ; Observer Variation ; Outcome and Process Assessment (Health Care) ; Pediatrics ; Pediatrics - standards ; Reliability ; Reproducibility of Results ; Severity of Illness Index ; triage ; Triage - methods ; Validity</subject><ispartof>Academic emergency medicine, 2009-09, Vol.16 (9), p.843-849</ispartof><rights>2009 by the Society for Academic Emergency Medicine</rights><rights>(c) 2009 by the Society for Academic Emergency Medicine</rights><rights>Copyright Hanley & Belfus, Inc. Sep 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4454-171c2e0714e71b2d3a0f46d854b2bfa0b3a3e28f3c863d6859f18b9eb084af883</citedby><cites>FETCH-LOGICAL-c4454-171c2e0714e71b2d3a0f46d854b2bfa0b3a3e28f3c863d6859f18b9eb084af883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1553-2712.2009.00494.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1553-2712.2009.00494.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19845551$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Travers, Debbie A.</creatorcontrib><creatorcontrib>Waller, Anna E.</creatorcontrib><creatorcontrib>Katznelson, Jessica</creatorcontrib><creatorcontrib>Agans, Robert</creatorcontrib><title>Reliability and Validity of the Emergency Severity Index for Pediatric Triage</title><title>Academic emergency medicine</title><addtitle>Acad Emerg Med</addtitle><description>Objectives: The Emergency Severity Index (ESI) triage algorithm is a five‐level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all‐age population, but has not been well studied for pediatric triage. This study assessed the reliability and validity of the ESI for pediatric triage at five sites.
Methods: Interrater reliability was measured with weighted kappa for 40 written pediatric case scenarios and 100 actual patient triages at each of five research sites (independently rated by both a triage nurse and a research nurse). Validity was evaluated with a sample of 200 patients per site. The ESI ratings were compared with outcomes, including hospital admission, resource consumption, and ED length of stay.
Results: Interrater reliability was 0.77 (95% confidence interval [CI] = 0.76 to 0.78) for the scenarios (n = 155 nurses) and 0.57 (95% CI = 0.52 to 0.62) for actual patients (n = 498 patients). Inconsistencies in triage were noted for the most acute and least acute patients, as well as those less than 1 year of age and those with medical (rather than trauma) chief complaints. For the validity cohort (n = 1,173 patients), outcomes differed by ESI level, including hospital admission, which went from 83% for Level 1 patients to 0% for Level 5 (chi‐square, p < 0.0001). Nurses from dedicated pediatric EDs were 31% less likely to undertriage patients than nurses in general EDs (odds ratio [OR] = 0.31, 95% CI = 0.14 to 0.67).
Conclusions: Reliability of the ESI for pediatric triage is moderate. The ESI provides a valid stratification of pediatric patients into five distinct groups. We found several areas in which nurses have difficulty triaging pediatric patients consistently. The study results are being used to develop pediatric‐specific ESI educational materials to strengthen reliability and validity for pediatric triage.</description><subject>Algorithms</subject><subject>Child</subject><subject>Documentation</subject><subject>Emergencies - classification</subject><subject>Emergency medical care</subject><subject>Emergency Treatment - methods</subject><subject>Emergency Treatment - nursing</subject><subject>Humans</subject><subject>Nursing Staff, Hospital - standards</subject><subject>Nursing Staff, Hospital - statistics & numerical data</subject><subject>Observer Variation</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Pediatrics</subject><subject>Pediatrics - standards</subject><subject>Reliability</subject><subject>Reproducibility of Results</subject><subject>Severity of Illness Index</subject><subject>triage</subject><subject>Triage - methods</subject><subject>Validity</subject><issn>1069-6563</issn><issn>1553-2712</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkD1PwzAQhi0EglL4C8hiYUrwZ-IMDFVVoFIRCAqr5STn4ipNwGmh_fc4tAKJiVvurHvulfUghCmJaajLeUyl5BFLKYsZIVlMiMhEvN5DvZ_FfphJkkWJTPgROm7bOSFEpll6iI5opoSUkvbQ3SNUzuSucssNNnWJX0zlyu7RWLx8BTxagJ9BXWzwE3yA7zbjuoQ1to3HD1A6s_SuwFPvzAxO0IE1VQunu95Hz9ej6fA2mtzfjIeDSVQIIUVEU1owICkVkNKcldwQK5JSSZGz3BqSc8OBKcsLlfAyUTKzVOUZ5EQJY5XifXSxzX3zzfsK2qVeuLaAqjI1NKtWp1yQTIqUBvL8DzlvVr4On9OMhTgasACpLVT4pm09WP3m3cL4jaZEd8L1XHdededVd8L1t3C9Dqdnu_xVvoDy93BnOABXW-DTVbD5d7AeDEd3YeJfliqNaw</recordid><startdate>200909</startdate><enddate>200909</enddate><creator>Travers, Debbie A.</creator><creator>Waller, Anna E.</creator><creator>Katznelson, Jessica</creator><creator>Agans, Robert</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>200909</creationdate><title>Reliability and Validity of the Emergency Severity Index for Pediatric Triage</title><author>Travers, Debbie A. ; Waller, Anna E. ; Katznelson, Jessica ; Agans, Robert</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4454-171c2e0714e71b2d3a0f46d854b2bfa0b3a3e28f3c863d6859f18b9eb084af883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Algorithms</topic><topic>Child</topic><topic>Documentation</topic><topic>Emergencies - classification</topic><topic>Emergency medical care</topic><topic>Emergency Treatment - methods</topic><topic>Emergency Treatment - nursing</topic><topic>Humans</topic><topic>Nursing Staff, Hospital - standards</topic><topic>Nursing Staff, Hospital - statistics & numerical data</topic><topic>Observer Variation</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Pediatrics</topic><topic>Pediatrics - standards</topic><topic>Reliability</topic><topic>Reproducibility of Results</topic><topic>Severity of Illness Index</topic><topic>triage</topic><topic>Triage - methods</topic><topic>Validity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Travers, Debbie A.</creatorcontrib><creatorcontrib>Waller, Anna E.</creatorcontrib><creatorcontrib>Katznelson, Jessica</creatorcontrib><creatorcontrib>Agans, Robert</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Academic emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Travers, Debbie A.</au><au>Waller, Anna E.</au><au>Katznelson, Jessica</au><au>Agans, Robert</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reliability and Validity of the Emergency Severity Index for Pediatric Triage</atitle><jtitle>Academic emergency medicine</jtitle><addtitle>Acad Emerg Med</addtitle><date>2009-09</date><risdate>2009</risdate><volume>16</volume><issue>9</issue><spage>843</spage><epage>849</epage><pages>843-849</pages><issn>1069-6563</issn><eissn>1553-2712</eissn><abstract>Objectives: The Emergency Severity Index (ESI) triage algorithm is a five‐level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all‐age population, but has not been well studied for pediatric triage. This study assessed the reliability and validity of the ESI for pediatric triage at five sites.
Methods: Interrater reliability was measured with weighted kappa for 40 written pediatric case scenarios and 100 actual patient triages at each of five research sites (independently rated by both a triage nurse and a research nurse). Validity was evaluated with a sample of 200 patients per site. The ESI ratings were compared with outcomes, including hospital admission, resource consumption, and ED length of stay.
Results: Interrater reliability was 0.77 (95% confidence interval [CI] = 0.76 to 0.78) for the scenarios (n = 155 nurses) and 0.57 (95% CI = 0.52 to 0.62) for actual patients (n = 498 patients). Inconsistencies in triage were noted for the most acute and least acute patients, as well as those less than 1 year of age and those with medical (rather than trauma) chief complaints. For the validity cohort (n = 1,173 patients), outcomes differed by ESI level, including hospital admission, which went from 83% for Level 1 patients to 0% for Level 5 (chi‐square, p < 0.0001). Nurses from dedicated pediatric EDs were 31% less likely to undertriage patients than nurses in general EDs (odds ratio [OR] = 0.31, 95% CI = 0.14 to 0.67).
Conclusions: Reliability of the ESI for pediatric triage is moderate. The ESI provides a valid stratification of pediatric patients into five distinct groups. We found several areas in which nurses have difficulty triaging pediatric patients consistently. The study results are being used to develop pediatric‐specific ESI educational materials to strengthen reliability and validity for pediatric triage.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>19845551</pmid><doi>10.1111/j.1553-2712.2009.00494.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Algorithms Child Documentation Emergencies - classification Emergency medical care Emergency Treatment - methods Emergency Treatment - nursing Humans Nursing Staff, Hospital - standards Nursing Staff, Hospital - statistics & numerical data Observer Variation Outcome and Process Assessment (Health Care) Pediatrics Pediatrics - standards Reliability Reproducibility of Results Severity of Illness Index triage Triage - methods Validity |
| title | Reliability and Validity of the Emergency Severity Index for Pediatric Triage |
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