Durani Yamini, Brecher Deena, Walmsley Daniel, Attia Magdy W, Loiselle John M
Division of Pediatric Emergency Medicine, Department of Pediatrics, Alfred I. duPont Hospital for Children/Thomas Jefferson University, 1600 Rockland Rd, Wilmington, DE 19899, USA.
Pediatr Emerg Care. 2009 Aug;25(8):504-7. doi: 10.1097/PEC.0b013e3181b0a0c6.
The Emergency Severity Index version 4 (ESI v.4) is a triage system, which demonstrates reliability in adult populations, however, it has not been extensively studied in pediatrics. The goal of this study was to measure interrater reliability and agreement rates within and between a group of pediatric emergency medicine physicians and pediatric triage (PT) nurses using ESI v.4 in a pediatric population.
Pediatric emergency medicine physicians and PT nurses completed ESI v.4 training and a survey of 20 pediatric case scenarios, requiring them to assign a triage category to each case. Cases and standardized responses were adapted from the ESI v.4 training materials. Unweighted and weighted kappa was measured, and agreement rates for each group were compared with the standard response.
Sixteen physicians and 17 nurses completed the study. The group had a mean of 10.2 (+/-7.7) years experience in pediatrics. Nurses had a mean of 7.6 (+/-8.7) years experience in triage. Unweighted kappa for physicians and nurses was 0.68 and 0.67, respectively. Weighted kappa for physicians and nurses was 0.92 and 0.93, respectively. The agreement rate among physicians and nurses with the standardized responses to case scenarios was 83%.
ESI v.4 is a reliable tool for triage assessments in pediatric patients when used by experienced pediatric emergency medicine physicians and PT nurses. It is a triage system with high agreement between physicians and nurses.
急诊严重程度指数第4版（ESI v.4）是一种分诊系统，已在成人人群中证明具有可靠性，然而，其在儿科领域尚未得到广泛研究。本研究的目的是在儿科人群中，使用ESI v.4测量一组儿科急诊医学医生和儿科分诊（PT）护士内部以及之间的评分者间信度和一致率。
儿科急诊医学医生和PT护士完成了ESI v.4培训以及一项包含20个儿科病例场景的调查，要求他们为每个病例分配一个分诊类别。病例和标准化回复改编自ESI v.4培训材料。测量了未加权和加权kappa值，并将每组的一致率与标准回复进行比较。
16名医生和17名护士完成了研究。该组在儿科领域的平均工作经验为10.2（±7.7）年。护士在分诊方面的平均工作经验为7.6（±8.7）年。医生和护士的未加权kappa值分别为0.68和0.67。医生和护士的加权kappa值分别为0.92和0.93。医生和护士对病例场景标准化回复的一致率为83%。
当由经验丰富的儿科急诊医学医生和PT护士使用时，ESI v.4是用于儿科患者分诊评估的可靠工具。它是一种医生和护士之间一致性较高的分诊系统。
