Emergency severity index compared with 4-level triage at the emergency department of Ramathibodi University Hospital
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.
Background
Emergency department (ED) triage is important for categorizing and prioritizing patients. Effective triage may assist in crowd reduction in the ED and appropriate patient management. There are several systems, including the 5-level Emergency Severity Index (ESI) and the 4-level Ramathibodi-nurse triage. Currently, there are limited data by which to compare the 5- versus 4-level triage; particularly on health outcomes, such as length of stay in the ED, mortality, and resource needs.
Objective
To compare the accuracy of 5- and 4-level triage in an ED.
Method
This observational study was conducted on a cross-section of patients in the ED at Ramathibodi Hospital of Mahidol University, Bangkok, Thailand. Eligible patients were those who visited the ED and were evaluated by ESI and nurse triage. Each evaluation was blinded to the results of the other. Discrimination performance between the 5- and 4-level triage was compared by using the area under a receiver operating characteristic (ROC) curve and concordance statistic for prediction of life saving intervention. Net reclassification improvement (NRI) of the 5-level ESI over the 4-level triage was performed.
Result
Study criteria were met by 520 patients. The areas under the ROC curves of the ESI and nurse triage on life-saving intervention were 92.2% (95% confidence intervals were 87.3%, 96.9%) and 81.3% (95% CI 75.2%, 87.3%), respectively. Areas under the ROC curve differed significantly (P < 0.001). The overall reclassification improvement was 42.4%.
Conclusion
The 5-level emergency severity index was more accurate than the 4-level triage in terms of lifesaving intervention.