Refining emergency severity index triage criteria

Paula Tanabe*, Debbie Travers, Nicki Gilboy, Alex Rosenau, Gina Sierzega, Valerie Rupp, Zoran Martinovich, James G. Adams

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


Objectives: The Emergency Severity Index (ESI) version 3 is a five-level triage acuity scale with demonstrated reliability and validity. Patients are rated from ESI level 1 (highest acuity) to ESI level 5 (lowest acuity). Clinical experience has demonstrated two levels of ESI 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 ESI level 1, and it has been suggested that revisions to the ESI 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 1 patients. Methods: This was a multisite, prospective study. The authors identified ESI level 2 patients who required immediate, lifesaving intervention and calculated chi-square statistics and odds ratios for variables that predicted which ESI level 2 patients actually received immediate intervention. Results: Immediate lifesaving interventions were provided for 117 (20.2%) 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 ESI level 2 patients were associated with immediate delivery of lifesaving interventions. Revisions to the ESI level 1 criteria may be beneficial.

Original languageEnglish (US)
Pages (from-to)497-501
Number of pages5
JournalAcademic Emergency Medicine
Issue number6
StatePublished - Jun 2005


  • Emergency department
  • Emergency severity index
  • Triage

ASJC Scopus subject areas

  • Emergency Medicine


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