New evidence is in, on ESI for pediatric triage
Infants difficult to triage
The Emergency Severity Index (ESI) Version 4 is widely accepted as a reliable triage tool for adults. There is now more evidence of its effectiveness in children. When researchers asked ED physicians and nurses to assign a triage level to 20 pediatric case scenarios, they found that the agreement rate was 83%.1
"There have been studies on ESI in pediatrics, but they are limited. Most of the studies have been in adults," says Yamini Durani, MD, the study's lead author and an ED physician at Alfred I. duPont Hospital for Children in Wilmington, DE. "Our study and prior studies by other authors support ESI as a potential universal triage tool for adult and pediatric patients," says Durani.2
However, a different study indicated that the use of the ESI for pediatrics has some room for improvement.3 Researchers identified areas in which ED nurses had difficulty triaging patients consistently when using the ESI at three general EDs and two pediatric EDs.
Debbie A. Travers, PhD, RN, FAEN, assistant professor of health care systems and emergency medicine at the University of North Carolina at Chapel Hill's School of Nursing, is a co-developer of ESI. "The big thing we found was that general EDs which see only some children tend to have more trouble, particularly with infants as a group," she says. "We found that infants were particularly hard to triage." There was undertriage and overtriage, she says. "And it's important to reduce both. As EDs get more and more crowded, it's really important that people who aren't that sick don't take the last bed," Travers says.
Travers is working on a follow-up study to see if ED nurses' accuracy rates improve after an educational intervention targeting pediatric triage. The intervention consisted of a one-hour computerized graphic presentation given by an ED nurse educator. This presentation was based on a newly written pediatric chapter for the ESI handbook, which will be included in future editions. "We hope to improve the reliability with education specific to using ESI to assign an acuity level for children," says Travers.
References
- Durani Y, Brecher D, Walmsley D, et al. The Emergency Severity Index Version 4: Reliability in pediatric patients. Ped Emerg Care 2009; 25:504-507.
- Eitel DR, Travers DA, Rosenau AM, et al. The emergency severity index triage algorithm version 2 is reliable and valid. Acad Emerg Med 2003; 10:1,070-1,080.
- Travers DA, Waller AE, Katznelson J, et al. Reliability and validity of the Emergency Severity Index for pediatric triage. Acad Emerg Med 2009; 16:843-849.
Sources
For more information on pediatric triage, contact:
- Yamini Durani, MD, Division of Emergency Medicine, Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, DE. E-mail: [email protected].
- Rosie Rodriguez-Henderson, RN/MHL, Advanced Clinician, Pediatric Emergency Department, Baptist Children's Hospital, Miami. Phone: (786) 596-6966. E-mail: [email protected].
- Debbie Travers, PhD, RN, FAEN, School of Nursing, University of North Carolina at Chapel Hill. Phone: (919) 966-5357. Fax: (919) 966-7298. E-mail: [email protected].
Get on eye level with child at triage Imagine how frightened a small child can quickly become in a crowded, noisy ED, having strangers asking questions and examining them. This fear can interfere with your triage assessment. "This often leads to crying and makes your examination more difficult," says Rosie Rodriguez-Henderson, RN/MHL, advanced clinician in the pediatric ED at Baptist Children's Hospital in Miami. To reduce anxiety, keep the child close to the parent or caregiver at all times, she says. "This helps them to feel safe and stay calm," she says. "Also, sit at their eye level. Having someone towering over you can be intimidating." |
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