2019 Volume 22 Issue 6 Pages 753-760
The Emergency Severity Index (ESI) is a triage tool used for patient assessment in the emergency department (ED). The ESI rates patients based on acuity and predicted resource requirement, from level 1 (resuscitation) to level 5 (non urgent). The Japan triage and acuity scale (JTAS) is frequently used for emergency patients, and the ESI has not been evaluated against the JTAS in Japan. This study aimed to examine differences in urgent decision accuracy in simulated scenarios with triage nurses using the ESI and JTAS. A parallel-group randomized trial was conducted. Eighteen JTAS-trained triage nurses, from 3 Japanese EDs, were randomly assigned to the ESI group or JTAS group. Nurses independently assigned triage scores to 100 emergency cases. Four indexes were used: accuracy, each urgency accuracy of rating individual category-stage, answer time, and a subjective usability. There were no significant differences in age, clinical experience, or JTAS experience between groups. A quadratically weighted kappa was used to measure inter-observer reliability; the ESI was superior to the JTAS in concordance rate (0.82 [0.80-0.85] and 0.74 [0.71-0.77], respectively). For all rating categories, except level 5, the Fleiss’ κ was higher in the ESI group. The ESI was more sensitive for category level 2, as an indication of high-risk situations, than the JTAS. However, no significant difference showed in answer time or usability. These findings suggest that the ESI could be a more useful triage tool, and has a greater sensitivity for detecting patient abnormalities in Japanese EDs than the JTAS.
