Tanabe Paula, Travers Debbie, Gilboy Nicki, Rosenau Alex, Sierzega Gina, Rupp Valerie, Martinovich Zoran, Adams James G
Department of Emergency Medicine, Institute for Health Services Research and Policy Studies, Northwestern University, Chicago, IL, USA.
Acad Emerg Med. 2005 Jun;12(6):497-501. doi: 10.1197/j.aem.2004.12.015.
The Emergency Severity Index (ESI) version 3 is a five-level triage acuity scale with demonstrated reliability and validity. Patients are rated from ESI level 1 (highest acuity) to ESI level 5 (lowest acuity). Clinical experience has demonstrated two levels of ESI level 2 patients: those who require immediate intervention and those who are stable to wait for at least ten minutes. Studies have found that few patients are rated ESI level 1, and it has been suggested that revisions to the ESI might result in appropriate reclassification of some sickest level 2 patients as level 1. The purpose of this study was to identify level 2 patients who might be reclassified as level 1 patients.
This was a multisite, prospective study. The authors identified ESI level 2 patients who required immediate, lifesaving intervention and calculated chi-square statistics and odds ratios for variables that predicted which ESI level 2 patients actually received immediate intervention.
Immediate lifesaving interventions were provided for 117 (20.2%) of the 589 patients included in the study. Seventeen predictors of the need for immediate intervention were identified. The strongest predictor was the triage nurse's judgment of the need for immediate intervention, especially airway and medications.
Specific clinical findings at triage for a subset of ESI level 2 patients were associated with immediate delivery of lifesaving interventions. Revisions to the ESI level 1 criteria may be beneficial.
急诊严重程度指数（ESI）第3版是一种五级分诊 acuity 量表，已证明具有可靠性和有效性。患者从ESI 1级（最高 acuity）到ESI 5级（最低 acuity）进行分级。临床经验表明，ESI 2级患者有两种情况：需要立即干预的患者和可以稳定等待至少十分钟的患者。研究发现，很少有患者被评为ESI 1级，有人建议对ESI进行修订可能会导致一些病情最严重的2级患者被适当重新分类为1级。本研究的目的是确定可能被重新分类为1级患者的2级患者。
这是一项多地点前瞻性研究。作者确定了需要立即进行挽救生命干预的ESI 2级患者，并计算了预测哪些ESI 2级患者实际接受立即干预的变量的卡方统计量和优势比。
研究纳入的589例患者中，有117例（20.2%）接受了立即挽救生命的干预。确定了17个需要立即干预的预测因素。最强的预测因素是分诊护士对立即干预必要性的判断，尤其是气道和药物方面。
ESI 2级患者亚组在分诊时的特定临床发现与立即进行挽救生命的干预有关。对ESI 1级标准进行修订可能会有益处。
