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Accuracy of Emergency Severity Index Score for the Triage of Emergency Department Patients with Suspected Acute Coronary Syndrome.

Jennifer Stemler, Salah Al-Zaiti, PhD, RN, ANP-BC, FAHA, Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, 3500 Victoria Street, 336 Victoria Building, Pittsburgh, PA 15213 Ervin Sejdić, PhD, Department of Electrical and Computer Engineering, Swanson School of Engineering, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, 5607 Baum Boulevard, Suite 500, Pittsburgh, PA 15206-3701 Clifton Callaway, MD, PhD, Department of Emergency Medicine, University of Pittsburgh, 3600 Forbes at Meyran Avenue, Forbes Tower, Suite 10028 Pittsburgh, PA 15213 Stephanie O. Frisch, PhD, RN, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, 5607 Baum Boulevard, Suite 500, Pittsburgh, PA 15206-3701

Background/Purpose: Acute coronary syndrome (ACS) is a life-threatening and time-sensitive condition that requires prompt identification at the initial emergency department (ED) nurse encounter to ensure positive patient outcomes. This study aims to describe the accuracy of triaging patients with a final diagnosis of ACS into the “high acuity” group based on guidelines of the Emergency Severity Index (ESI) triage tool. 

Methods: This is a secondary analysis of a retrospective observational cohort study of adult ED patients, from 17 EDs, who were potentially having an ACS event. Based on the ESI guidelines, a score of 1 or 2 (high acuity) is considered accurate for patients who have a final diagnosis of ACS. ESI score and final ED/in-hospital diagnosis were extracted from the electronic health record and compared.

Results: Our sample included 1201 patients with a mean (SD) age of 65 (14) years, 89% white, 1% Hispanic, and 54% male. Of these, 522 (44%) patients had a final diagnosis of ACS. ESI score was not documented in 109 cases. ESI score 1–2 (high acuity) was assigned to 750 (62%) patients and 342 (29%) patients were assigned ESI score 3–5 (middle/low acuity). The area under the receiver operating characteristic curve for a high acuity ESI and the final diagnosis of ACS was 0.586 (95% confidence interval of 0.552–0.620). 

Conclusion & Implications: Accurate ESI score was determined in just over half of the cases in this data set. Many patients with ACS were given “low acuity” scores, and potentially under-triaged. Patients suspected of having ACS and who are under-triaged could experience delays in patient care and timely treatments, potentially leading to worse patient outcomes. 




Additional Abstract Information

Presenter: Jennifer Stemler

Institution: University of Pittsburgh School of Nursing

Type: Oral

Subject: Nursing & Public Health

Status: Approved


Time and Location

Session: Oral 8
Date/Time: Tue 5:00pm-6:00pm
Session Number: 838
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