Accuracy of Emergency Room Triage Using Emergency Severity Index (ESI): Independent Predictor of Under and Over Triage

Abstract

Introduction Patient saturation in emergency care departments is a significant issue that impacts the healthcare system globally. This study was purposed to evaluate the accuracy of the ER triage using the Emergency Severity Index (ESI). Methodology A prospective observational study was performed at Hayatabad Medical Complex, Peshawar, from October 2020 to March 2021. Data from one of the second largest hospitals in Khyber Pakhtunkhwa were acquired to carry out this study. All data from our emergency department have been retrieved and recorded using appropriate procedures and software. Triage accuracy has been established by comparing proposed resource consumption (acuity level 3-5) to the actual resources utilized in these hospitals as the amount of an agreement between standard guidelines and local observations. In terms of resource expenditure, we also assessed the interconnection between acuity level and extent of accuracy. SPSS version 21 (IBM Inc., Armonk, New York) was used to document and analyze all of the data. Results The greatest odds of undertriage to moderate acuity were associated with age ≥65 years; OR 1.49, 95% CI (1.25-1.72) and OR 2.18 CI (1.22-3.73) for under-triage to low acuity designations. Severe hypoxia, severe bradycardia, and severe tachycardia were all strongly linked with the risk of under-triage of moderate-acuity levels OR 2.19 95% CI (1.49-3.13); OR 2.54 (1.53-4.01); and OR 2.17 (1.61-2.88), respectively. Essentially, there were also significant associations with under-triage to moderate acuity due to the lack of oxygen saturation measurement. Hypertension (≥200mmHg) was linked with increased odds of undertriage to moderate acuity with OR 1.29 95% CI (0.68-2.01). There were no anomalous vital signs associated with an increased likelihood of over-triage to high and moderate ESI acuity levels. Conclusion Our study indicated that increasing the age of patients was a significant factor associated with odds of under-triage. Furthermore, certain vital signs, including severe bradycardia, tachycardia, and severe hypoxia, were connected to the risk of under-triage of moderate acuity. Further, large-scale and multicenter studies should be conducted to assess other triage systems, which may provide a more accurate and reliable approach to evaluate the severity of patients' injuries by the hospital staff and physicians in the emergency room. They should be translated to local languages to assign treatment priorities in a structured and dependable manner.

Keywords: bradycardia; emergency room; hypoxia; oxygen saturation; tachycardia; triage.