Evaluation of the Performance Emergency Severity Index in the Triage of Trauma Patients Referred to the Emergency Department of Ashayer Shohada Khorramabad Hospital in 2023: A Cross-Sectional Study

The triage system of the emergency department prioritizes patients to receive medical care, and errors in prioritizing patients can have serious consequences. This study aims to evaluate the Performance Emergency Severity Index in the triage of trauma patients referred to the emergency department of Ashayer Shohada Khorramabad Hospital in 2023.

The current cross-sectional study was conducted using an available sampling method on 375 trauma patients referred to the emergency department. First, the reliability of the Emergency Severity Index (ESI) triage was calculated by examining the agreement between observers (inter-rater reliability) and Cohen's kappa statistical test. Then, to validate the levels of severity, in the absence of a gold standard, the outcome of trauma patients was used as an alternative marker. Researchers compared the results of nurse's triage for each of the outcomes, and based on this comparison, the validity of ESI triage was evaluated in terms of heavy and light triage. The obtained data were analyzed using STATA-17 software, and the chi-square test was used to validate the triage. A value of P<0.05 was considered statistically significant.

The findings of the present study showed that the percentage of patients assigned to levels one; two, three, four, and five were 2.94, 15.2, 61.6, 12.53, and 7.73, respectively. Kappa calculated from the inter-rater agreement for ESI triage was determined to be 0.7. The ESI triage system generally had an error in 23.2% of the performed care prioritization.

According to findings, ESI triage has high inter-rater reliability in performance. In terms of validity however, it needs a serious review, and most of the trauma patients are placed at the level of three ESI triages, and a large collection of undifferentiated patients is created, which weakens the main purpose of triage.