Emergency Severity Index (ESI): A Triage Tool for Emergency ...

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Chapter 5. The Role of Vital Signs in ESI Triage Gilboy N, Tanabe P, Travers DA, Eitel DR, Wuerz RC (2003). The Emergency Severity Index Implementation Handbook: A Five-Level Triage System. Des Plaines, IL: Emergency Nurses Association. Rangel-Frausto M, Pittet D, Costigan M, Hwang T, Davis C, Wenzel R (1995). The natural history of the systemic inflammatory response syndrome (SIRS): A prospective study. JAMA. 273:117-123. Stedman's Medical Dictionary (26th ed) (1995). Baltimore: Williams & Wilkins. Wuerz R, Milne LW, Eitel DR, Travers D, Gilboy N (2000). Reliability and validity of a new five-level triage instrument. Acad Emerg Med, 7(3):236-242. Wuerz R, Travers D, Gilboy N, Eitel DR, Rosenau A, Yazhari R (2001). Implementation and refinement of the emergency severity index. Acad Emerg Med, 8(2):170-176. 40
Chapter 6. Use of the ESI for Pediatric Triage This chapter addresses the use of the Emergency Severity Index (ESI) algorithm for triage of patients less than 18 years of age. The chapter incorporates issues identified during a study conducted by the Pediatric ESI Research Consortium (Travers et al., 2006) and from a review of the pediatric triage literature (Hohenhaus et al., 2008), both of which were funded by the Health Services and Resources Administration (HRSA). The chapter can help general hospital and pediatric nurses quickly and accurately assess children in the ED triage setting. The chapter is meant to serve as guidance for all hospitals regarding use of the ESI for pediatric triage. It is not intended to serve as a substitute for a course on pediatric triage or pediatric emergency care, nor for local policies regarding triage (e.g., whether or not febrile children are treated with anti-pyretics at triage if they go to the waiting room). Introduction In the current emergency department (ED) environment of crowding, emerging infectious diseases, and natural disasters, it is important to have a reliable triage system in place that allows for rapid and accurate assessment of patients. This is particularly important for the most vulnerable ED populations, which include children. Nationwide, there are an estimated 30 million ED visits per year for patients under 18 years of age, accounting for one-fourth of all ED visits (Middleton & Burt, 2006). Children’s physiological and psychological responses to stressors are not the same as those of adults, and they are more susceptible to a range of injuries and illnesses, from viruses to dehydration to radiation sickness. Given their often limited ability to communicate with care providers, children can be more difficult to rapidly and accurately assess than their adult counterparts. Triage tools such as the ESI algorithm are designed to prioritize ED patients for treatment. The earliest version of the ESI was intended for use only with patients greater than age 14 (Wuerz et al., 2000). In 2000, specific pediatric vital sign criteria were added to the ESI version 2; this version is intended for triage of patients of any age (Wuerz et al., 2001). While the ESI has been shown to produce valid, reliable triage of the general ED population, recent 41 studies of its utility for pediatric patients indicate room for improvement. Hinrichs and colleagues (2005) found low intra- and inter-rater reliability among nurses using the ESI for infant triage. In another single-site study of ESI version 3, researchers conducted a retrospective chart review of pediatric triage decisions and found variable reliability among triage nurses, nurse investigators, and physician investigators with a moderate level of agreement (Baumann et al., 2005). The information in this chapter is based on the results of the multi-center study of pediatric triage and a comprehensive review of the pediatric literature. The Pediatric ESI Research Consortium conducted a large, multi-center study of the ESI for pediatric triage and found that, while the overall reliability of ESI version 4 is good, pediatric cases are more often mistriaged than adult cases (Travers et al., 2006). The study evaluated both reliability and validity of the ESI for children, enrolling 155 nurses and 498 patients in the reliability evaluation and 1,173 patients in the validity evaluation across 7 hospitals in 3 states. The sites included urban, rural, suburban, academic, and community hospitals and two dedicated pediatric EDs. The researchers found that nurses make more accurate ESI ratings for trauma cases than medical cases (Katznelson et al., 2006) and that certain types of pediatric patients are harder to triage, including infants, psychiatric patients, and those with fever, rashes, or respiratory problems (Rosenau et al., 2006). The Pediatric ESI Research Consortium’s comprehensive review of the pediatric literature included 15 emergency courses and pediatric emergency text books, and the goal of the review was to identify best practices and best evidence relevant to ED triage of children (Hohenhaus et al., 2008). The review noted both strengths and areas for improvement in the existing literature. Strengths included the use of case scenarios for teaching and the existence of many courses that facilitate education on pediatric assessment during emergencies. Areas for improvement included a lack of evidence-based normal pediatric vital sign parameters; the need for a standardized, interdisciplinary approach to assessment and history taking; and the need for more pediatric triagespecific case scenarios for educational use.
Page 1 and 2: Emergency Severity Index (ESI) A Tr
Page 3 and 4: Emergency Severity Index (ESI) A Tr
Page 5 and 6: Note From the Director The Agency f
Page 7 and 8: Preface The Emergency Severity Inde
Page 9 and 10: Contents Chapter 1. Introduction to
Page 11 and 12: Chapter 1. Introduction to the Emer
Page 17 and 18: Chapter 2. Overview of the Emergenc
Page 27 and 28: Chapter 3. ESI Level 2 cluster of c
Page 29 and 30: Chapter 3. ESI Level 2 • Sepsis
Page 31 and 32: Chapter 3. ESI Level 2 Toxicologica
Page 33 and 34: Chapter 3. ESI Level 2 Table 3-1. E
Page 35 and 36: Chapter 3. ESI Level 2 2. Is the Pa
Page 37 and 38: Chapter 3. ESI Level 2 References E
Page 39 and 40: Chapter 4. ESI Levels 3-5 and Expec
Page 41 and 42: Chapter 4. ESI Levels 3-5 and Expec
Page 43 and 44: Chapter 5. The Role of Vital Signs
Page 45 and 46: those triaged as ESI level 3. The r
Page 47: A 72-year-old patient presents to t
Page 51 and 52: to the safe care of a child. Method
Page 53 and 54: at triage. Febrile children over th
Page 55 and 56: ESI Level 2 As with assigning an ES
Page 57 and 58: Table 6-6. Examples of Pediatric Tr
Page 59 and 60: Children with Co-Morbid Conditions
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Page 63 and 64: The ED leadership team will ultimat
Page 65 and 66: will help assure reliability and va
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Page 69 and 70: • E-mails to remind staff of the
Page 71 and 72: Chapter 8. Evaluation and Quality I
Page 77 and 78: The cases in this chapter are provi
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Page 81 and 82: 56 EMS arrives with a 42-year-old m
Page 83 and 84: 84. EMS arrives with a 75-year-old
Page 85 and 86: 14. ESI level 2: High risk. A tempe
Page 87 and 88: 46. ESI level 4: One resource. The
Page 89 and 90: 77. ESI level 5. No resources. No r
Page 91 and 92: Chapter 10. Competency Cases This c
Page 93 and 94: Set B Competency Cases 1. “Withou
Page 95 and 96: 6. ESI level 2: High risk. Rashes a
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Appendix A. Frequently Asked Questi
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Appendix B. ESI Triage Algorithm, v
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Appendix C. Abbreviations and Acron
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Notes: A. Immediate life-saving int
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