Emergency severity index compared with 4-level triage at the emergency department of Ramathibodi University Hospital
, , , and | Jan 31, 2017
About this article
Article Category: Brief communication (Original)
Published Online: Jan 31, 2017
Page range: 155 - 161
DOI: https://doi.org/10.5372/1905-7415.1002.477
Keywords
© 2016 Chaiyaporn Yuksen, Sorravit Sawatmongkornkul, Supakrid Suttabuth, Kittisak Sawanyawisuth, Yuwares Sittichanbuncha
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Figure 1
Characteristics of patients visiting the ED who underwent both ESI and nursing triage assessment
| Factors | Numbers (percentage) or median (range) |
|---|---|
| Male sex | 216 (41.5%) |
| Age, years | 51 (0.4-97) |
| Trauma | 93 (17.9) |
| Final status | |
| Discharge | 441 (84.8) |
| Admitted | 50 (9.6) |
| Operative room | 11 (2.1) |
| Referred | 14 (2.7) |
| Refused treatment | 3 (0.58) |
| Death | 1 (0.19) |
| Resource needs | |
| None | 97 (18.7) |
| 1 | 116 (22.3) |
| ≥2 | 307 (59.0) |
| Life-saving intervention | 32 (6.2) |
| Nursing triage (4 level) | |
| 1 | 8 (1.5) |
| 2 | 180 (34.6) |
| 3 | 332 (63.9) |
| 4 | 0 |
| ESI triage (5 level) | |
| 1 | 14 (2.7) |
| 2 | 92 (17.7) |
| 3 | 225 (43.3) |
| 4 | 116 (22.3) |
| 5 | 73 (14.0) |
| Length of stay in ED, hours | 2.54 (0.25-169) |
| Death | 2 (0.38) |
Characteristics of patients by the 4-level nurse triage
| Factors | Category | ||
|---|---|---|---|
| 1 Critical (n = 8) | 2 Emergency (n = 180) | 3 Urgent (n = 332) | |
| Median ED length of stay (range), hours | 9.50 (0.75-153) | 3.94 (0.5-169) | 2 (0.25-124) |
| Resource needs | |||
| None | 0 | 13 (7.2%) | 84 (25.3%) |
| 1 | 0 | 27 (15.0%) | 89 (26.8%) |
| ≥2 | 8 (100%) | 140 (77.8%) | 159 (47.9%) |
| Final status | |||
| Discharged | 2 (25%) | 143 (79.4%) | 315 (94.9%) |
| Admitted to wards | 5 (63%) | 23 (12.8%) | 14 (4.2%) |
| Admitted to ICU | 1 (13%) | 14 (7.8%) | 3 (0.9%) |
| Life-saving intervention | |||
| Users (n= 32) | 5 (63%) | 24 (13%) | 3 (0.9%) |
| Death | 0 | 1 (0.6%) | 1 (0.3%) |
Characteristics of all patients by ESI triage
| Factors | Classifications | ||||
|---|---|---|---|---|---|
| 1 (n = 14) | 2 (n = 64) | 3 (n = 205) | 4 (n = 114) | 5 (n = 73) | |
| Median ED length of stay (range), hours | 4.83 | 8.67 | 3.41 | 1.62 | 0.86 |
| (0.75-153.5) | (0.5-169) | (0.5-124) | (0.41-34.17) | (0.25–4) | |
| Resource needs | |||||
| None | 0 | 2 (2%) | 14 (6%) | 17 (15%) | 64 (88%) |
| 1 | 0 | 5 (5%) | 32 (14%) | 71 (61%) | 8 (11%) |
| ≥2 | 14 (100) | 85 (92%) | 179 (80%) | 28 (24%) | 1 (1%) |
| Final status | |||||
| Discharged | 4 (29%) | 64 (69%) | 205 (91%) | 114 (99%) | 73 (100%) |
| Admitted to wards | 3 (21%) | 20 (22%) | 17 (8%) | 2 (2%) | 0 |
| Admitted to ICU | 7 (50%) | 8 (9%) | 3 (1%) | 0 | 0 |
| Life-saving intervention | |||||
| Users (n= 32) | 13 (93%) | 17 (19%) | 2 (1%) | 0 | 0 |
| Death | 2 | 0 | 0 | 0 | 0 |
Immediate life-saving interventions at the emergency departmentAdapted from [13].
| Life-saving | Not life-saving | |
|---|---|---|
| Airway /breathing | ΒVM ventilation | Oxygen administration |
| Intubation | Nasal cannula | |
| Surgical airway | Non-rebreather | |
| Emergency continuous positive airway pressure | ||
| Emergency bilevel positive airway pressure | ||
| Electrical therapy | Defibrillation | Cardiac monitor |
| Emergency cardioversion | ||
| External pacing | ||
| Procedures | Chest needle decompression | Diagnostic Test |
| Pericardiocentesis | - Electrocardiography | |
| Open thoracotomy | - Laboratory test values | |
| Intraosseous access | - Ultrasound | |
| - Focused abdominal scan for trauma | ||
| Hemodynamics | Significant intravenous fluid resuscitation | Intravenous access |
| Blood administration | ||
| Control of major bleeding | Saline lock for medications | |
| Medications | Naloxone | Acetylsalicylic acid |
| Intravenous 50% dextrose | Intravenous nitroglycerine | |
| Dopamine | Antibiotics | |
| Atropine | Heparin | |
| Adenocard | Pain medications | |
| Respiratory treatments with beta agonists |
Reclassification improvement of receivers and non-receivers of life-saving interventions (LSI) and net reclassification improvement
| LSIuse | 4 level triage | ESI triage | Total | ||
|---|---|---|---|---|---|
| Level 3 | Level 2 | Level 1 | |||
| Yes | Level 3 | 2 | 0 | 1 | 3 |
| Level 2 | 0 | 16 | 8 | 24 | |
| Level 1 | 0 | 1 | 4 | 5 | |
| Total | 2 | 17 | 13 | 32 | |
| Reclassification improvementLSI = (9-1) /32 = 0.250 | |||||
| No | Level 3 | 314 | 15 | 0 | 329 |
| Level 2 | 98 | 58 | 0 | 156 | |
| Level 1 | 0 | 2 | 1 | 3 | |
| Total | 412 | 75 | 1 | 488 | |
| Reclassification improvementnon-LSI = (100-15) /488 = 0.174 | |||||
Resource needs at the emergency department
| Resource needs | No resource need |
|---|---|
| Laboratory test values (blood, urine) | History, physical |
| Electrocardiography, X-ray imaging, computed tomography, magnetic resonance imaging, ultrasound angiography | Point-of-care testing |
| Intravenous fluids (hydration) | Saline or heparin lock |
| Intravenous fluids, intramuscular, or nebulized medications | Per oral medications |
| Tetanus immunization | |
| Prescription refills | |
| Specialty consultation | Phone call to primary care physician |
| Simple procedure = 1 (Laceration repair, Foley catheter) | Simple wound care (dressings, recheck) |
| Complex procedure = 2 (conscious sedation) | Crutches, splints, slings |