Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis

被引：110

作者：

Hinson J.S. ^{[1
]}

Martinez D.A. ^{[1
,2
]}

Schmitz P.S.K. ^{[3
]}

Toerper M. ^{[1
,2
]}

Radu D. ^{[3
]}

Scheulen J. ^{[1
]}

Stewart de Ramirez S.A. ^{[1
]}

Levin S. ^{[1
,2
,4
,5
]}

机构：

[1] Department of Emergency Medicine, Johns Hopkins University School of Medicine, 801 Smith Avenue, Davis Building, Suite 3220, Baltimore, 21209, MD

[2] Department of Operations Integration, Johns Hopkins Hospital, Baltimore, MD

[3] Emergency Department, Hospital Moinhos de Vento, Porto Alegre

[4] Whiting School of Engineering, Johns Hopkins University, Baltimore, MD

[5] Systems Institute, Johns Hopkins University, Baltimore, MD

来源：

International Journal of Emergency Medicine | 2018年 / 11卷 / 1期

基金：

美国医疗保健研究与质量局;

关键词：

Emergency department; Emergency severity index; Mistriage; Triage;

D O I：

10.1186/s12245-017-0161-8

中图分类号：

学科分类号：

摘要：

Background: Emergency department (ED) triage is performed to prioritize care for patients with critical and time-sensitive illness. Triage errors create opportunity for increased morbidity and mortality. Here, we sought to measure the frequency of under- and over-triage of patients by nurses using the Emergency Severity Index (ESI) in Brazil and to identify factors independently associated with each. Methods: This was a single-center retrospective cohort study. The accuracy of initial ESI score assignment was determined by comparison with a score entered at the close of each ED encounter by treating physicians with full knowledge of actual resource utilization, disposition, and acute outcomes. Chi-square analysis was used to validate this surrogate gold standard, via comparison of associations with disposition and clinical outcomes. Independent predictors of under- and over-triage were identified by multivariate logistic regression. Results: Initial ESI-determined triage score was classified as inaccurate for 16,426 of 96,071 patient encounters. Under-triage was associated with a significantly higher rate of admission and critical outcome, while over-triage was associated with a lower rate of both. A number of factors identifiable at time of presentation including advanced age, bradycardia, tachycardia, hypoxia, hyperthermia, and several specific chief complaints (i.e., neurologic complaints, chest pain, shortness of breath) were identified as independent predictors of under-triage, while other chief complaints (i.e., hypertension and allergic complaints) were independent predictors of over-triage. Conclusions: Despite rigorous and ongoing training of ESI users, a large number of patients in this cohort were under- or over-triaged. Advanced age, vital sign derangements, and specific chief complaints—all subject to limited guidance by the ESI algorithm—were particularly under-appreciated. © 2018, The Author(s).

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