Accuracy of the Emergency Severity Index Triage Instrument for Identifying Elder Emergency Department Patients Receiving an Immediate Life‐saving Intervention

Abstract

Objectives: The study objective was to determine the sensitivity and specificity of the Emergency Severity Index (ESI) triage instrument for the identification of elder patients receiving an immediate life-saving intervention in the emergency department (ED). Methods:The authors reviewed medical records for consecutive patients 65 years or older who presented to a single academic ED serving a large community of elders during a 1-month period. ESI triage scores were compared to actual ED course with attention to the occurrence of an immediate life-saving intervention. The sensitivity and specificity of an ESI triage level of 1 for the identification of patients receiving an immediate intervention was calculated. For 50 cases, the triage nurse ESI designation was compared to the triage level determined by an expert triage nurse based on retrospective record review.Results: Of 782 consecutive patients 65 years or older who presented to the ED, 18 (2%) had an ESI level of 1, 176 (23%) had an ESI level of 2, 461 (60%) had an ESI level of 3, 100 (13%) had an ESI level of 4, and 18 (2%) had an ESI level of 5. Twenty-six patients received an immediate life-saving intervention. ESI triage scores for these 26 individuals were as follows: ESI 1, 11 patients; ESI 2, nine patients; and ESI 3, six patients. The sensitivity of ESI to identify patients receiving an immediate intervention was 42.3% (95% confidence interval [CI] = 23.3% to 61.3%); the specificity was 99.2% (95% CI = 98.0% to 99.7%). For 17 of 50 cases in which actual triage nurse and expert nurse ESI levels disagreed, undertriage by the triage nurses was more common than overtriage (13 vs. 4 patients). Conclusions:The ESI triage instrument identified fewer than half of elder patients receiving an immediate life-saving intervention. Failure to follow established ESI guidelines in the triage of elder patients may contribute to apparent undertriage.ACADEMIC EMERGENCY MEDICINE 2010; 17:238-243 ª

Evaluating the accuracy of emergency nurses in correct triage using emergency severity index triage in Sina hospital of Tabriz: a cross-sectional analysis

“…Tanabe et al confirmed the high reliability of five-level triage, and reported a high reliability for it (Kappa = 0.89) (13). Some studies reported that ESI is a valid and reliable method for better allocation of resources and better classification of patients to get appropriate treatment (14,15). In the first moment of the patient's admission to ER, demographic data (age, sex, date, time of patient's referral and cause of admission) were obtained.…”

“…According to Kariman et al, the sensitivity of ESI in identification of old patients who should receive lifepreserving interventions was low (5). As Platts-Mills et al reported, this can be related to the fact that nurses did not triage patients directly; they only referred to the patient's past medical history (15). Although the majority of patients experienced correct triage, but 12% experienced undertriage and 11.1% experienced overtriage.…”

Prevalence of Nonmedical Problems Among Older Adults Presenting to the Emergency Department

“…65 It is also possible that the enrollment process enriched the sample with patients who were admitted because patients who were flagged for discharge were not eligible, and patients who anticipated going home might have been more reluctant to participate in a study that might prolong their ED visit. Consistent with this, 21 patients were not screened because they were flagged as discharged prior to being screened, 18 patients refused the screener, and three patients were eligible but declined participation because they thought it would take too much time (Figure 1).…”

A Profile of Acute Care in an Aging America: Snowball Sample Identification and Characterization of United States Geriatric Emergency Departments in 2013

“…32,33 Although experts hypothesize about the essential components of a high-quality geriatric ED, 34,35 we provide early research to systematically identify and qualitatively characterize the existence, locations, and features of geriatric EDs across the United States. These descriptive details will be essential in understanding the variety of services offered and evaluation methods.…”