Pediatric emergency medicine trisk 0126 0126
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Comprehensive triage has been the dominant model for assigning triage acuity
in U.S. EDs. Triage acuity systems have been based on the nurse’s assessment of
vital signs and physical examination along with subjective information including
past medical history, medications, allergies, and history of the presenting
complaint. These systems require the nurse to assign an acuity level by
determining how acutely ill the patient is and how long they can wait to be seen
by a provider.
The ESI is a five-level triage system developed by a group of emergency
physicians and nurses in the late 1990s. The ESI is distinctive in its method of
triage as it integrates both acuity and resource utilization. This system relies on
nursing judgment for the more acutely ill patients (ESI levels 1 and 2), while
asking nurses to assign lesser acuities (ESI levels 3 to 5) to the less acutely ill by
predicting the number of resources such as diagnostic tests and procedures each
patient will need in determining disposition. Triage nurses follow an algorithm
for determining acuity ( Fig. 6.1 ). The nurse answers specific questions for
determining the more acutely ill at points A and B. Point B takes into
consideration special high-risk conditions in pediatrics ( Table 6.1 ). If the child
is determined to be less acute, direction is given to what constitutes a resource
and nurses are only required to estimate up to two resources ( Table 6.2 ).
Multiple studies of general ED populations have validated the ESI triage system
with good interrater reliability and the ability to estimate ED resources when
triage was performed by trained, experienced ED nurses.
The ESI tool has continually been validated and improved upon through
research. ESI version 4 (2012 edition) was born out of the Pediatric ESI Research
Consortium’s large, multicenter study on pediatric triage and a comprehensive
review of pediatric emergency courses and textbooks. Improvements to ESI
included a designated chapter on pediatric triage and more pediatric triage case
scenarios for educational use.
In 2009 the American Hospital Association reported that 57% of U.S. hospitals
were using the ESI triage system. Standardization of triage systems across the
United States allows for increased sharing of ED data and setting performance
metrics for care. Establishing a standard for triage acuity assessment further
facilitates benchmarking, public health surveillance, and research.
The National Center for Health Statistics at the Centers for Disease Control and
Prevention reports national level data on ED visits. The report categorizes
patients in five levels on how urgently they need to be seen by a provider and
includes immediate (immediately), emergent (1 to 14 minutes), urgent (15 to 60
minutes), semiurgent (1 to 2 hours), nonurgent (2 to 24 hours). While there is no
