Jafari-Rouhi Amir Hossein, Sardashti Sara, Taghizadieh Ali, Soleimanpour Hassan, Barzegar Mohammad
Pediatric Health Research Center, Tabriz Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Int J Emerg Med. 2013 Oct 2;6(1):36. doi: 10.1186/1865-1380-6-36.
The Emergency Severity Index (ESI) has earned reliability and validity in adult populations but has not been adequately evaluated in pediatric patients. The aim of this study was to assess the reliability of the ESI version 4 and inter-rater reliability measures to evaluate the performance of nurses in the emergency ward.
Raters were part of the same team of pediatric emergency medicine team, including pediatric emergency medicine (PEM) physicians and pediatric triage (PT) nurses. Reliability and agreement rates were measured using kappa statistics. The measurements were compared with the admission rates, readmissions to the PEM division, location of admission and death as outcomes.
Initially, PT nurses rated 20 case scenarios. Further in a prospective cohort study, 1104 children were assigned ESI scores by both nurses and physicians. The ratings of case scenarios showed a kappa value of 0.84. In actual patients, ratings showed high concordance with the physicians' ratings with the kappa value of 0.82 being in a good agreement with the nurses' ratings. The main area of discordance was detected in level 4 where 48 cases were triaged in higher levels and 25 were triaged in lower levels. The analysis showed the likelihood of admission clearly increased as the ESI score decreased (p<0.0001). There was a significant correlation between the admission status and triage level in both PT nurses' and PEM physicians' ratings (Spearman coefficient=0.374, 0.407; p<0.0001).
ESI scores assigned to the pediatric patients are reliable in the hands of experienced PT nurses and PEM physicians. The very good agreement between PT nurses and PEM physicians, demonstrated in this study, is essential in cooperative work in crowded referral emergency departments and helpful in challenging triage cases.
急诊严重程度指数（ESI）在成人患者群体中已获得可靠性和有效性，但在儿科患者中尚未得到充分评估。本研究的目的是评估第4版ESI的可靠性以及评估急诊病房护士表现的评分者间可靠性指标。
评分者来自儿科急诊医学团队的同一组人员，包括儿科急诊医学（PEM）医生和儿科分诊（PT）护士。使用kappa统计量测量可靠性和一致率。将测量结果与入院率、再次入住PEM科室的情况、入院地点和死亡情况作为结果进行比较。
最初，PT护士对20个病例场景进行了评分。在进一步的前瞻性队列研究中，护士和医生都为1104名儿童分配了ESI评分。病例场景评分的kappa值为0.84。在实际患者中，评分与医生的评分高度一致，kappa值为0.82，与护士的评分一致性良好。主要不一致的领域在4级，有48例被分诊到更高级别，25例被分诊到更低级别。分析表明，随着ESI评分降低，入院可能性明显增加（p<0.0001）。PT护士和PEM医生的评分中，入院状态与分诊级别之间存在显著相关性（Spearman系数=0.374，0.407；p<0.0001）。
在经验丰富的PT护士和PEM医生手中，分配给儿科患者的ESI评分是可靠的。本研究中PT护士和PEM医生之间非常好的一致性，对于拥挤的转诊急诊科的合作工作至关重要，并且有助于处理具有挑战性的分诊病例。
