Importance Most emergency departments (EDs) across the US use the Emergency Severity Index (ESI) to predict acuity and resource needs. A comprehensive assessment of ESI accuracy among pediatric patients is lacking. Objective To assess the frequency of mistriage using ESI (version 4) among pediatric ED visits using automated measures of mistriage and identify characteristics associated with mistriage. Design, Setting, and Participants This cohort study used operational measures for each ESI level to classify encounters as undertriaged, overtriaged, or correctly triaged to assess the accuracy of the ESI and identify characteristics of mistriage. Participants were pediatric patients at 21 EDs within Kaiser Permanente Northern California from January 1, 2016, to December 31, 2020. During that time, version 4 of the ESI was in use by these EDs. Visits with missing ESI, incomplete ED time variables, patients transferred from another ED, and those who left against medical advice or without being seen were excluded. Data were analyzed between January 2022 and June 2023. Exposures Assigned ESI level. Main Outcomes and Measures Rates of undertriage and overtriage by assigned ESI level based on mistriage algorithm, patient and visit characteristics associated with undertriage and overtriage. Results This study included 1 016 816 pediatric ED visits; the mean (SD) age of patients was 7.3 (5.6) years, 479 610 (47.2%) were female, and 537 206 (52.8%) were male. Correct triage occurred in 346 918 visits (34.1%; 95% CI, 34.0%-34.2%), while overtriage and undertriage occurred in 594 485 visits (58.5%; 95% CI, 58.4%-58.6%) and 75 413 visits (7.4%; 95% CI, 7.4%-7.5%), respectively. In adjusted analyses, undertriage was more common among children at least 6 years old compared with those younger 6 years; male patients compared with female patients; patients with Asian, Black, or Hispanic or other races or ethnicities compared with White patients; patients with comorbid illnesses compared with those without; and patients who arrived by ambulance compared with nonambulance patients. Conclusions and Relevance This multicenter retrospective study found that mistriage with ESI version 4 was common in pediatric ED visits. There is an opportunity to improve pediatric ED triage, both in early identification of critically ill patients (limit undertriage) and in more accurate identification of low-acuity patients with low resource needs (limit overtriage). Future research should include assessments based on version 5 of the ESI, which was released after this study was completed.

中文翻译：

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紧急严重程度指数第 4 版和儿科急诊科患者的分诊。


重要性 美国大多数急诊科 (ED) 使用紧急严重程度指数 (ESI) 来预测病情严重程度和资源需求。缺乏对儿科患者 ESI 准确性的全面评估。目的 使用 ESI（第 4 版）自动测量误诊来评估儿科急诊就诊中误诊的频率，并确定与误诊相关的特征。设计、设置和参与者 这项队列研究使用每个 ESI 级别的操作措施将遭遇分类为分类不足、过度分类或正确分类，以评估 ESI 的准确性并识别错误分类的特征。参与者是 2016 年 1 月 1 日至 2020 年 12 月 31 日期间北加州 Kaiser Permanente 内 21 个急诊室的儿科患者。在此期间，这些急诊室使用的是 ESI 第 4 版。缺少ESI、不完整的急诊室时间变量、从另一个急诊室转来的患者以及不顾医疗建议离开或没有就诊的患者被排除在外。数据在 2022 年 1 月至 2023 年 6 月期间进行分析。暴露指定的 ESI 水平。主要结果和措施 根据错误分类算法、与分类不足和过度分类相关的患者和就诊特征，按指定的 ESI 水平划分分类不足和分类过度的比率。结果 本研究包括 1 016 816 名儿童急诊就诊；患者的平均年龄（SD）为7.3（5.6）岁，其中女性479 610例（47.2%），男性537 206例（52.8%）。正确分类发生在 346 918 次就诊中（34.1%；95% CI，34.0%-34.2%），过度分类和分类不足发生在 594 485 次就诊（58.5%；95% CI，58.4%-58.6%）和 75 413 次就诊（分别为 7.4%；95% CI，7.4%-7.5%。 在调整后的分析中，与 6 岁以下的儿童相比，6 岁以上儿童的分类不足更为常见；男性患者与女性患者的比较；与白人患者相比，亚裔、黑人、西班牙裔或其他种族或民族的患者；患有合并症的患者与没有合并症的患者进行比较；以及乘坐救护车到达的患者与非救护车患者的比较。结论和相关性 这项多中心回顾性研究发现，ESI 第 4 版的误诊在儿科急诊就诊中很常见。有机会改进儿科急诊分诊，无论是早期识别危重患者（限制分诊不足）还是更准确地识别资源需求低的低危患者（限制过度分诊）。未来的研究应包括基于 ESI 第 5 版的评估，该版本是在本研究完成后发布的。