nach oben

Notfall + Rettungsmedizin

Erschienen in:

01.05.2016 | Originalien

Triage using the Emergency Severity Index (ESI) and seven versus three vital signs

verfasst von: Y. K. Gunaydin, M.D., A. Çağlar, K. Kokulu, C. G. Yıldız, Z. D. Dündar, N. B. Akilli, R. Koylu, B. Cander

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 3/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The aim of this study was to compare sensitivity and validity of the emergency severity index (ESI) using 3 vital signs vs. the modified ESI (mESI) with 7 vital signs.

Methods

This prospective, observational study comprised all patients without trauma (>18 years old), presenting between 1 September 2014 and 1 October 2014 from 08:00–16:00 h, and having ESI triage scores levels 3, 4, and 5. Different from the ESI, 7 vital signs for patients in levels 3, 4, and 5 were determined. When the result revealed an abnormality in at least one of the 7 vital signs, these patients were designated as level 2 and the mESI triage was applied to them.

Results

A total of 4536 patients were included in the study. Comparing the hospitalized patient group and the patients treated as outpatients according to the ESI and mESI levels, the ESI and the mESI level median values were 4 (3–4) and 3 (2–4), respectively, and those of patients treated on an outpatient basis were 4 (4–5) and 4 (3–5). A significant difference was observed between the two groups with regard to both the ESI and the mESI scores (p < 0.001). Furthermore, when the ESI and the mESI were compared with regard to the sensitivity and the reliability in determining the patients for hospitalization, a significant difference was determined favoring ESI [ROC curve: area under the curve mESI: 0.690, 95 % confidence interval (Cl) 0.666–0.713; ESI 0.753, 95 % Cl 0.733–0.774; p < 0.001].

Conclusion

The ESI, in which 3 vital signs are measured in order to distinguish only level 2 and 3 patients, is an adequate and reliable triage system.

Vorheriger Artikel Arztbegleiteter Patiententransport

Nächster Artikel Pneumomediastinum

Gilboy N, Tanabe T, Travers D et al (2011) Emergency Severity Index (ESI): a triage tool for emergency department care, version 4. AHRQ Publication No.12-0014. Agency for Healthcare Research and Quality, Rockville

Elshove-Bolk J, Mencl F, van Rijswijck BT et al (2007) Validation of the emergency severity index (ESI) in self-referred patients in a european emergency department. Emerg Med J 24:170–174CrossRefPubMedPubMedCentral

Storm-Versloot MN, Ubbink DT, Chin a Choi V et al (2009) Observer agreement of the Manchester triage system and the emergency severity index: a simulation study. Emerg Med J 26:556–560CrossRefPubMed

Tanabe P, Gimbel R, Yarnold PR et al (2004) Reliability and validity of scores on the emergency severity index version 3. Acad Emerg Med 11:59–65CrossRefPubMed

Chi CH, Huang CM (2006) Comparison of the emergency severity index (ESI) and the Taiwan triage system in predicting resource utilization. J Formos Med Assoc 105:617–625CrossRefPubMed

Eitel DR, Travers DA, Rosenau AM et al (2003) The emergency severity index triage algorithm version 2 is reliable and valid. Acad Emerg Med 10:1070–1080CrossRefPubMed

van der Wulp I, Rullmann HAA, Leenen LP et al (2011) Associations of the emergency severity index triage categories with patients’ vital signs at triage: a prospective observational study. Emerg Med J 28:1032–1035CrossRefPubMed

Wuerz RC, Milne LW, Eitel DR et al (2000) Reliability and validity of a new five-level triage instrument. Acad Emerg Med 7:236–242CrossRefPubMed

Wuerz RC, Travers D, Gilboy N et al (2001) Implementation and refinement of the emergency severity index. Acad Emerg Med 8:170–176CrossRefPubMed

10.

Platts-Mills TF, Travers D, Biese K et al (2010) Accuracy of the emergency severity index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med 17:238–243CrossRefPubMed

11.

Worster A, Fernandes CM, Eva K et al (2007) Predictive validity comparison of twofive-level triage acuity scales. Eur J Emerg Med 14:188–192CrossRefPubMed

12.

American College of Emergency Physicians. ER 101: Vital Signs (2014) ACEP: December 11

13.

American Diabetes Association (2015) Standards of medical care in diabetes. Diabetes Care 38(Suppl 1):S1–S93

14.

Berger T, Green J, Horeczko T et al (2013) Shock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med 14(2):168–174CrossRefPubMedPubMedCentral

15.

American Hospital Association Chartbook. Trends affecting hospitals and health systems. http://www.aha.org/research/reports/tw/chartbook/ch3.shtml. Zugegriffen: 9. Juni 2013

16.

Handel D, Epstein S, Khare R et al (2011) Intervention to improve the timeliness of emergency care. Acad Emerg Med 18:1295–1302CrossRefPubMed

17.

Ward MJ, Farley J, Khare RK et al (2011) Achieving efficiency in crowded emergency departments: a research agenda. Acad Emerg Med 18:1303–1312CrossRefPubMed

18.

Institute of Medicine (ed) (2006) Hospital-based emergency care: at the breaking point. National Academies Press, Washington, DC

19.

Singer AJ, Thode HC Jr, Viccellio P et al (2011) The association between length of emergency department boarding and mortality. Acad Emerg Med 18:1324–1329CrossRefPubMed

20.

McCarthy ML, Zeger SL, Ding R et al (2009) Crowding delays treatment and lengthens emergency department length of stay, even among high acuity patients. Ann Emerg Med 54:492–503CrossRefPubMed

21.

Pines JM, Luyer S, Disbot M et al (2008) The effect of emergency department crowding on patient satisfaction for admitted patients. Acad Emerg Med 15:825–831CrossRefPubMed

22.

Pines JM, Pollack CV Jr, Diercks DB et al (2009) The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain. Acad Emerg Med 16:617–625CrossRefPubMed

23.

Bernstein SL, Aronsky D, Duseja R et al (2009) The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med 16:1–10CrossRefPubMed

24.

Arya R, Wei G, McCoy JV et al (2013) Decreasing length of stay in the emergency department with a split emergency severity index 3 patient flow model. Acad Emerg Med 20:1171–1179CrossRefPubMed

25.

Kenward G, Hodgets T, Castle N (2001) Time to put the R back in TPR. Nurs Times 97:32–33PubMed

26.

Alcock K, Clancy M, Crouch R (2002) Physiological observations of patients admitted from A & E. Nurs Stand 8:33–37CrossRef

27.

McQuillan P, Pilkington S, Allan A et al (1998) Confidential inquiry into quality of care before admission to intensive care. BMJ 316:1853–1858CrossRefPubMedPubMedCentral

28.

McGloin H, Adam SK, Singer M (1999) Unexpected deaths and referrals to intensive care of patients from general wards. Are some cases potentially avoidable? J R Coll Physicians Lond 33:255–259PubMed

29.

Buist MD, Moore GE, Bernard SA et al (2002) Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 324:387–390CrossRefPubMedPubMedCentral

30.

Subbe CP, Kruger M, Rutherford P et al (2001) Validation of a modified early warning score in medical admissions. Q J Med 94:521–526CrossRef

31.

Armstrong B, Walthall H, Clancy M et al (2008) Recording of vital signs in a district general hospital emergency department. Emerg Med J 25:799–802CrossRefPubMed

32.

Olsson T, Terent A, Lind L (2004) Rapid emergency medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med 255:579–587CrossRefPubMed

33.

Goodacre S, Turner J, Nicholl J (2006) Prediction of mortality among emergency medical admissions. Emerg Med J 23:372–375CrossRefPubMedPubMedCentral

34.

Saberi F, Heyland D, Lam M et al (2008) Prevalence, incidence, and clinical resolution of insulin resistance in critically ill patients: an observational study. JPEN J Parenter Enteral Nutr 32(3):227–235CrossRefPubMed

35.

Jones AE, Stiell IG, Nesbitt LP et al (2004) Nontraumatic out-of-hospital hypotension predicts inhospital mortality. Ann Emerg Med 43:106–113CrossRefPubMed

36.

Heckbert SR, Vedder NB, Hoffman W et al (1998) Outcome after hemorrhagic shock in trauma patients. J Trauma 45:545–549CrossRefPubMed

37.

Seymour CW, Cooke CR, Heckbert SR et al (2013) Prehospital systolic blood pressure thresholds: a Community-based outcomes study. Acad Emerg Med 20:597–604CrossRefPubMed

38.

Rady M, Nightingale P, Little R et al (1992) Shock index: a re-evaluation in acute circulatory failure. Resuscitation 23:227–234CrossRefPubMed

39.

Rady M, Rivers EP, Martin G et al (1992) Continuous central venous oximetry and shock index in the emergency department: use in the evaluation of clinical shock. Am J Emerg Med 10:538–541CrossRefPubMed

40.

Rady M, Smithline H, Blake H et al (1994) A comparison of the shock index and conventional vital signs to identify acute, critical illness in the emergency department. Ann Emerg Med 24:685–690CrossRefPubMed

41.

Maningas PA, Hime DA, Parker DE et al (2006) The soterion rapid triage system: evaluation of inter-rater reliability and validity. J Emerg Med 30:461–469CrossRefPubMed

42.

Dent A, Rofe G, Sansom G (1999) Which triage category patients die in hospital after being admitted through emergency departments? A study in one teaching hospital. Emerg Med 11:68–71CrossRef

43.

Doherty SR, Hore CT, Curran SW (2003) Inpatient mortality as related to triage category in three New South Wales regional base hospitals. Emerg Med (Fremantle) 15:334–340CrossRef

44.

Baumann MR, Strout TD (2007) Triage of geriatric patients in the emergency department: validity and survival with the Emergency Severity index. Ann Emerg Med 49:234–240CrossRefPubMed

45.

Travers DA, Waller AE, Bowling JM et al (2002) Five-level triage system moreeffective than three-level in tertiary emergency department. J Emerg Nurs 28:395–400CrossRefPubMed

46.

Kim TG, Cho JK, Kim SH et al (2006) Reliability and validity of the modifiedemergency severity index-2 as a triage tool. J Korean Soc. Emerg Med 17:154–164

Titel: Triage using the Emergency Severity Index (ESI) and seven versus three vital signs
verfasst von: Y. K. Gunaydin, M.D.
A. Çağlar
K. Kokulu
C. G. Yıldız
Z. D. Dündar
N. B. Akilli
R. Koylu
B. Cander
Publikationsdatum: 01.05.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Notfall + Rettungsmedizin / Ausgabe 3/2016
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI: https://doi.org/10.1007/s10049-015-0119-4

Springerpflege

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2016

Bakterielle Meningitis bei Erwachsenen im Not- und Rettungswesen

Funktionelle Symptome und somatoforme Störungen in der Notaufnahme

Akademische Betrachtung der längenbezogenen Gewichtsschätzung darf die klinische Anwendung nicht aus den Augen verlieren

Mitteilungen des GRC

Arztbegleiteter Patiententransport

Notfallpsychiatrische Suizidprävention