Eitel David R, Travers Debbie A, Rosenau Alexander M, Gilboy Nicki, Wuerz Richard C
Department of Emergency Medicine, The York Hospital, Wellspan Health, York, PA 17405, USA.
Acad Emerg Med. 2003 Oct;10(10):1070-80. doi: 10.1111/j.1553-2712.2003.tb00577.x.
Initial studies have shown improved reliability and validity of a new triage tool, the Emergency Severity Index (ESI), over conventional three-level scales at two university medical centers. After pilot implementation and validation, the ESI was revised to include pediatric and updated vital signs criteria. The goal of this study was to assess ESI version (v.) 2 reliability and validity at seven emergency departments (EDs) in three states.
In part 1, interrater reliability was assessed using weighted kappa analysis of written training cases and postimplementation by a random sampling of actual patient triages. In part 2, validity was analyzed using a prospective cohort with stratified random sampling at each site. The ESI was compared with outcomes including resource consumption, inpatient admission, ED length of stay, and 60-day all-cause mortality.
Weighted kappa analysis of interrater reliability ranged from 0.70 to 0.80 for the written scenarios (n = 3289) and 0.69 to 0.87 for patient triages (n = 386). Outcomes for the validity cohort (n = 1042) included hospitalization rates by ESI triage level: level 1, 83%; 2, 67%; 3, 42%; 4, 8%; level 5, 4%. Sixty-day all-cause mortality by triage level was as follows: level 1, 25%; 2, 4%; 3, 2%; 4, 1%; and 5, 0%.
ESI v. 2 triage produced reliable, valid stratification of patients across seven sites. ESI triage should be evaluated as an ED casemix identification system for uniform data collection in the United States and compared with other major ED triage methods.
初步研究表明，一种新的分诊工具——急诊严重程度指数（ESI），在两家大学医学中心比传统的三级量表具有更高的可靠性和有效性。在进行试点实施和验证后，ESI进行了修订，纳入了儿科和更新后的生命体征标准。本研究的目的是评估ESI第2版（v.）在三个州的七个急诊科（ED）的可靠性和有效性。
在第1部分中，通过对书面培训案例进行加权kappa分析以及对实际患者分诊进行随机抽样来评估实施后的评分者间信度。在第2部分中，使用前瞻性队列并在每个站点进行分层随机抽样来分析效度。将ESI与包括资源消耗、住院入院、急诊留观时间和60天全因死亡率在内的结果进行比较。
书面场景（n = 3289）的评分者间信度加权kappa分析范围为0.70至0.80，患者分诊（n = 386）的范围为0.69至0.87。效度队列（n = 1042）的结果包括按ESI分诊级别划分的住院率：1级，83%；2级，67%；3级，42%；4级，8%；5级，4%。按分诊级别划分的60天全因死亡率如下：1级，25%；2级，4%；3级，2%；4级，1%；5级，0%。
ESI v. 2分诊在七个站点对患者进行了可靠、有效的分层。ESI分诊应作为美国统一数据收集的急诊病例组合识别系统进行评估，并与其他主要的急诊分诊方法进行比较。
