Evaluation of the Significance of Vital Signs in the Up-Triage of Patients Visiting Emergency Department from Emergency Severity Index Level 3 to 2

  • Hooman Hossein Nejad Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Mohsen Banaie Mail Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Seyed Hossein Seyedhosseini Davarani Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Zahra Khazaeipour Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Emergency medicine, Heart rate, Oximetry, Respiratory rate, Triage

Abstract

The Emergency Severity Index (ESI) is a five-level triage system that has shown promising reliability and validity. According to ESI algorithm, in the presence of danger zone respiratory rate (RR), heart rate (HR) or Oxygen (O2) saturation, patients should be up-triaged from ESI level 3 to 2 Hence, the current study aimed to investigate the value of the measurement of vital signs in predicting the up-triage of patients from ESI level 3 to 2. Patients who visited the emergency department at Imam Khomeini Hospital Complex, Tehran, Iran, and were categorized into ESI level 3 were investigated. RR, HR, and O2 saturation were recorded by the triage nurse, and the rates of abnormalities in these three variables were evaluated. Out of 551 cases who were up-triaged from ESI level 3 to 2,489 (88.7%) had an increased RR, and 539 (97.8%) had an increased RR or HR. Only 12 cases (2.2%) had normal RR and HR, who were up-triaged only due to abnormal O2 saturation. Out of these 12 cases, 10 had O2 saturations <92% at common health status, 1 had acutely altered mental status and should have been triaged into ESI level 2 in the first place and 1 could not be located for further investigations. In conclusion, compared to O2 saturation, the abnormal findings during the assessment of RR and HR seem to much more commonly result in the up-triage of patients from ESI level 3 to 2.

References

Wuerz RC, Travers D, Gilboy N, Eitel DR, Rosenau A, Yazhari R. Implementation and refinement of the emergency severity index. Acad Emerg Med 2001;8:170-6.

Adams JG, Biros MH. The Endangered Safety Net Establishing a Measure of Control. Acad Emerg Med 2001;8:1013-5.

Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Acad Emerg Med 2000;7:236-42.

Tanabe P, Gimbel R, Yarnold PR, Kyriacou DN, Adams JG. Reliability and validity of scores on The Emergency Severity Index version 3. Acad Emerg Med 2004;11:59-65.

Worster A, Gilboy N, Fernandes CM, Eitel D, Eva K, Geisler R, et al. Assessment of the inter-observer reliability of two five-level triage and acuity scales: a randomized controlled trial. Can J Emerg Med 2004;6:240-5.

Eitel DR, Travers DA, Rosenau AM, Gilboy N, Wuerz RC. The emergency severity index triage algorithm version 2 is reliable and valid. Acad Emerg Med 2003;10:1070-80.

Travers DA, Waller AE, Bowling JM, Flowers D, Tintinalli J. Five-level triage system more effective than three-level in the tertiary emergency department. J EmergNurs 2002;28:395-400.

Goldhill D, White S, Sumner A. Physiological values andprocedures in the 24 h before ICU admission from the ward. Anaesthesia 1999;54:529-34.

Goldhill D, McNarry A. Physiological abnormalities in early warning scores are related to mortality in adult inpatients. Br J Anaesth 2004;92:882-4.

Gilboy N, Tanabe T, Travers D, Rosenau AM. Emergency Severity Index (ESI): A triage tool for emergency department. Rockville, MD: Agency for Healthcare Research and Quality. (Accessed March 08, 2016, at http://www. ahrq. gov/professionals/systems/hospital/esi/esi1.html.2011.

Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian JPsychol Med 2013;35:121-6.

Fieselmann JF, Hendryx MS, Helms CM, Wakefiels DS. Respiratory rate predicts cardiopulmonary arrest for internal medicine inpatients. J Gen Intern Med 1993;8:354-60.

Hodgetts TJ, Kenward G, Vlachonikolis IG, Payne S, Castle N. The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. Resuscitation 2002;54:125-31.

Goldhill D, McNarry A, Mandersloot G, McGinley A. A physiologically-based early warning score for ward patients: the association between score and outcome. Anaesthesia 2005;60:547-53.

Published
2016-06-08
How to Cite
1.
Hossein Nejad H, Banaie M, Seyedhosseini Davarani SH, Khazaeipour Z. Evaluation of the Significance of Vital Signs in the Up-Triage of Patients Visiting Emergency Department from Emergency Severity Index Level 3 to 2. Acta Med Iran. 54(6):366-369.
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Articles