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Victor Ban Jin Lim

Abstract

VALIDITY AND RELIABILITY OF EMERGENCY SEVERITY INDEX (ESI) AND CONVENTIONAL THREE-TIER TRIAGE SYSTEM IN EMERGENCY DEPARTMENT HOSPITAL UNIVERSITI SAINS MALAYSIA
Ban Jin Victor LIM, Shaik Farid AB WAHAB, Yee Cheng KUEH

Introduction: A valid and reliable triage system is imperative to an ED in efficiently separating those severely ill patients from the crowds and to be triaged into critical zone whereby treatment and resuscitation work could be carried out in time. ESI is a five-tier triaging system currently practiced in the United States. It triages all type of patients (trauma/non-trauma, pediatrics/adults/geriatrics) based on a single algorithm.
Material and Methods: This study was conducted in ED Hospital USM over two study periods. First three months, a total of 300 patients were triaged under three-tier triaging system. Subsequent three months, 280 patients were triaged under ESI. The patients were triaged by junior paramedics and the triage records were kept and later re-triaged by senior paramedics. The inter-rater reliability were compared using kappa statistics. The acuity ratings given by junior paramedics were compared with the expert panel’s acuity ratings to determine sensitivity and specificity for each acuity level for both ESI and three-tier triaging system. The over-triage rate, under-triage rate, amount of resources use, admission and discharge rate were also determined.
Results: The inter-rater agreement for three tier triaging system was 0.81 while the agreement for ESI triaging system was 0.75. ESI had higher average sensitivity of 74.3% and specificity of 94.4% compared to three-tier’s average sensitivity of 68.5% and specificity of 87.0%. The average under-triage rate and over-triage rate for ESI was 10.7% and 6.2%, lower compared to three-tier average under-triage rate of 13.1% and over-triage rate of 17.1%. The urgency levels of both ESI and three-tier triaging system were associated with increased admission rate and resources used in ED.
Discussion: The ESI had inter-rater reliability that was comparable to the three-level triaging system and had better validity than the existing three-tier triaging system.
Keywords: Emergency Severity Index, validity, reliability, triaging system

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Keywords

Emergency Severity Index, validity, reliability, triaging system

References
1. Sprivulis PC, Da Silva J-A, Jacobs IG, Jelinek GA, Frazer AR. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. The Medical Journal of Australia. 2006;184(5):208-12.
2. Gilboy N, Travers D, Wuerz R. Re-evaluating triage in the new millennium: a comprehensive look at the need for standardization and quality. Journal of Emergency Nursing. 1999;25(6):468-73.
3. Wuerz R, Fernandes CM, Alarcon J. Inconsistency of emergency department triage. Emergency Department Operations Research Working Group. Ann Emerg Med. 1998;32(4):431-5.
4. Rahmat MH, Annamalai M, Halim SA, Ahmad R, editors. Agent-based modelling and simulation of emergency department re-triage. Business Engineering and Industrial Applications Colloquium (BEIAC), 2013 IEEE; 2013: IEEE.
5. Dateo J. What factors increase the accuracy and inter-rater reliability of the Emergency Severity Index among emergency nurses in triaging adult patients? J Emerg Nurs. 2013;39(2):203-7.
6. Walls R. Dr. Richard Wuerz's Emergency Severity Index. Acad Emerg Med. 2001;8(2):183-4.
7. Eitel DR, Travers DA, Rosenau AM, Gilboy N, Wuerz RC. The emergency severity index triage algorithm version 2 is reliable and valid. Acad Emerg Med. 2003;10(10):1070-80.
8. Elshove-Bolk J, Mencl F, van Rijswijck BT, Simons MP, van Vugt AB. Validation of the Emergency Severity Index (ESI) in self-referred patients in a European emergency department. Emerg Med J. 2007;24(3):170-4.
9. Esmailian M, Zamani M, Azadi F, Ghasemi F. Inter-Rater Agreement of Emergency Nurses and Physicians in Emergency Severity Index (ESI) Triage. Emerg (Tehran). 2014;2(4):158-61.
10. Travers DA, Waller AE, Bowling JM, Flowers D, Tintinalli J. Five-level triage system more effective than three-level in tertiary emergency department. Journal of Emergency Nursing. 2002;28(5):395-400.
11. Storm-Versloot MN, Ubbink DT, Kappelhof J, Luitse JS. Comparison of an informally structured triage system, the emergency severity index, and the manchester triage system to distinguish patient priority in the emergency department. Acad Emerg Med. 2011;18(8):822-9.
12. Tanabe P, Gimbel R, Yarnold PR, Kyriacou DN, Adams JG. Reliability and validity of scores on The Emergency Severity Index version 3. Acad Emerg Med. 2004;11(1):59-65.
13. Chi CH, Huang CM. Comparison of the Emergency Severity Index (ESI) and the Taiwan Triage System in predicting resource utilization. J Formos Med Assoc. 2006;105(8):617-25.
14. Cohen J. A coefficient of agreement for nominal scales. Educational and psychological measurement. 1960;20(1):37-46.
15. Mirhaghi A, Heydari A, Mazlom R, Hasanzadeh F. Reliability of the Emergency Severity Index: Meta-analysis. Sultan Qaboos Univ Med J. 2015;15(1):e71-7.
16. Worster A, Sardo A, Eva K, Fernandes CM, Upadhye S. Triage tool inter-rater reliability: a comparison of live versus paper case scenarios. Journal of emergency nursing. 2007;33(4):319-23.
17. Maleki M, Fallah R, Riahi L, Delavari S, Rezaei S. Effectiveness of Five-Level Emergency Severity Index Triage System Compared With Three-Level Spot Check: An Iranian Experience. Arch Trauma Res. 2015;4(4):e29214.
18. Mirhaghi A, Kooshiar H, Esmaeili H, Ebrahimi M. Outcomes for emergency severity index triage implementation in the emergency department. J Clin Diagn Res. 2015;9(4):OC04-7.
19. Tanabe P, Gimbel R, Yarnold PR, Adams JG. The Emergency Severity Index (version 3) 5-level triage system scores predict ED resource consumption. J Emerg Nurs. 2004;30(1):22-9.
20. van der Wulp I, Schrijvers AJ, van Stel HF. Predicting admission and mortality with the Emergency Severity Index and the Manchester Triage System: a retrospective observational study. Emerg Med J. 2009;26(7):506-9.
21. van der Wulp I, Rullmann HA, Leenen LP, van Stel HF. Associations of the Emergency Severity Index triage categories with patients' vital signs at triage: a prospective observational study. Emerg Med J. 2011;28(12):1032-5.
22. Baumann MR, Strout TD. Triage of geriatric patients in the emergency department: validity and survival with the Emergency Severity Index. Ann Emerg Med. 2007;49(2):234-40.
23. Green NA, Durani Y, Brecher D, DePiero A, Loiselle J, Attia M. Emergency Severity Index version 4: a valid and reliable tool in pediatric emergency department triage. Pediatr Emerg Care. 2012;28(8):753-7.
Section
EMAS Meeting 2018 Abtracts