Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients With Active Cancer

David Adler¹, Beau Abar¹, Danielle D Durham², Aveh Bastani³, Steven L Bernstein⁴, Christopher W Baugh⁵, Jason J Bischof⁶, Christopher J Coyne⁷, Corita R Grudzen⁸, Daniel J Henning⁹, Matthew F Hudson¹⁰, Adam Klotz¹¹, Gary H Lyman¹², Troy E Madsen¹³, Daniel J Pallin⁵, Cielito C Reyes-Gibby¹⁴, Juan Felipe Rico¹⁵, Richard J Ryan¹⁶, Nathan I Shapiro¹⁷, Robert Swor¹⁸, Charles R Thomas Jr¹⁹, Arvind Venkat²⁰, Jason Wilson²¹, Sai-Ching Jim Yeung²², Jeffrey M Caterino⁶

Affiliations

¹ Department of Emergency Medicine, University of Rochester, Rochester, New York.
² Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
³ Department of Emergency Medicine, William Beaumont Hospital, Troy Campus, Troy, Michigan.
⁴ Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
⁵ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
⁶ Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
⁷ Department of Emergency Medicine, University of California San Diego, San Diego, California.
⁸ Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York.
⁹ Department of Emergency Medicine, University of Washington, Seattle, Washington.
¹⁰ Prisma Health-Upstate Cancer Institute, Greenville, South Carolina.
¹¹ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
¹² Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
¹³ Division of Emergency Medicine, University of Utah, Salt Lake City, Utah.
¹⁴ Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
¹⁵ Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida.
¹⁶ Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.
¹⁷ Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
¹⁸ Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan.
¹⁹ Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon.
²⁰ Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania.
²¹ Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida.
²² Department of Emergency Medicine, Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas.

PMID: 31353265
PMCID: PMC7478143
DOI: 10.1016/j.jemermed.2019.05.023

Observational Study

Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients With Active Cancer

David Adler et al. J Emerg Med. 2019 Sep.

. 2019 Sep;57(3):354-361.

doi: 10.1016/j.jemermed.2019.05.023. Epub 2019 Jul 26.

Authors

Affiliations

¹ Department of Emergency Medicine, University of Rochester, Rochester, New York.
² Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
³ Department of Emergency Medicine, William Beaumont Hospital, Troy Campus, Troy, Michigan.
⁴ Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
⁵ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
⁶ Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
⁷ Department of Emergency Medicine, University of California San Diego, San Diego, California.
⁸ Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York.
⁹ Department of Emergency Medicine, University of Washington, Seattle, Washington.
¹⁰ Prisma Health-Upstate Cancer Institute, Greenville, South Carolina.
¹¹ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
¹² Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
¹³ Division of Emergency Medicine, University of Utah, Salt Lake City, Utah.
¹⁴ Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
¹⁵ Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida.
¹⁶ Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.
¹⁷ Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
¹⁸ Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan.
¹⁹ Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon.
²⁰ Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania.
²¹ Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida.
²² Department of Emergency Medicine, Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas.

PMID: 31353265
PMCID: PMC7478143
DOI: 10.1016/j.jemermed.2019.05.023

Abstract

Background: Patients with active cancer account for a growing percentage of all emergency department (ED) visits and have a unique set of risks related to their disease and its treatments. Effective triage for this population is fundamental to facilitating their emergency care.

Objectives: We evaluated the validity of the Emergency Severity Index (ESI; version 4) triage tool to predict ED-relevant outcomes among adult patients with active cancer.

Methods: We conducted a prespecified analysis of the observational cohort established by the National Cancer Institute-supported Comprehensive Oncologic Emergencies Research Network's multicenter (18 sites) study of ED visits by patients with active cancer (N = 1075). We used a series of χ² tests for independence to relate ESI scores with 1) disposition, 2) ED resource use, 3) hospital length of stay, and 4) 30-day mortality.

Results: Among the 1008 subjects included in this analysis, the ESI distribution skewed heavily toward high acuity (>95% of subjects had an ESI level of 1, 2, or 3). ESI was significantly associated with patient disposition and ED resource use (p values < 0.05). No significant associations were observed between ESI and the non-ED based outcomes of hospital length of stay or 30-day mortality.

Conclusion: ESI scores among ED patients with active cancer indicate higher acuity than the general ED population and are predictive of disposition and ED resource use. These findings show that the ESI is a valid triage tool for use in this population for outcomes directly relevant to ED care.

Keywords: emergency department; emergency severity index; oncologic emergency; triage.

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References

1. Gilboy N, Tanabe P, Travers D, Rosenau AM. Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care Version 4 Implementation Handbook 2012 Edition. 2012 ed: Agency for Healthcare Research and Quality (AHRQ); 2011.
1. Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Acad Emerg Med. 2000;7:236–42. - PubMed
1. 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;11:59–65. - PubMed
1. 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;10:1070–80. - PubMed
1. 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;105:617–25. - PubMed

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Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients With Active Cancer

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Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients With Active Cancer

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