Refining emergency severity index triage criteria

Objectives: The Emergency Severity Index (EST) version 3 is a five-level triage acuity scale with demonstrated reliability and validity. Patients are rated from EST level I (highest acuity) to EST level 5 (lowest acuity). Clinical experience has demonstrated two levels of EST level 2 patients: those who require immediate intervention and those who are stable to wait for at least ten minutes. Studies have found that few patients are rated EST level 1, and it has been suggested that revisions to the EST might result in appropriate reclassification of some sickest level 2 patients as level 1. The purpose of this study was to identify level 2 patients who might be reclassified as level I patients. Methods: This was a multisite, prospective study. The authors identified EST level 2 patients who required immediate, lifesaving intervention and calculated chi-square statistics and odds ratios for variables that predicted which EST level 2 patients actually received immediate intervention. Results: Immediate lifesaving interventions were provided for 117 (20.20%) of the 589 patients included in the study. Seventeen predictors of the need for immediate intervention were identified. The strongest predictor was the triage nurse's judgment of the need for immediate intervention, especially airway and medications. Conclusions: Specific clinical findings at triage for a subset of EST level 2 patients were associated with immediate delivery of lifesaving interventions. Revisions to the EST level I criteria may be beneficial.