Comparison of START triage categories to emergency department triage levels to determine need for urgent care and to predict hospitalization
Keywords:ESI, START, triage, acuity, admission
Objective: To compare Emergency Severity Index (ESI) triage levels and Simple Triage and Rapid Treatment (START) triage colors for urgent care and hospitalization.
Design: Cross sectional.
Setting: Inner city emergency department (ED).
Participants: Patients years transported by Emergency Medical Services (EMS) participating in the state triage tag exercise, October 9-15, 2011.
Interventions: EMS assigned each patient a START triage tag. ED staff recorded tag number and color. Demographics, vital signs, 22 emergent interventions, and disposition were obtained via chart review. Institutional review board approval was obtained.
Main outcome measures: Presence of more than two abnormal vital sign on arrival and need for more than one emergent intervention in ED were considered indicators of acuity and severity. START triage colors were recategorized as urgent (Red, Yellow) and less acute (Green, White), and ESI was recategorized as urgent (1, 2, 3) and less acute (4, 5).
Results: Both ED and EMS staff were blinded to the study, and 95% confidence intervals were presented for statistical significance. Of 233 participants, START triage colors were Black = 0, Red = 12 percent, Yellow = 26 percent, Green = 53 percent, and White = 9 percent. ESI triage levels were level 1 = 1 percent, level 2 = 34 percent, level 3 = 51 percent, level 4 = 14 percent, and level 5 = 1 percent. ESI (1, 2, 3) identified 88 percent (75-95 percent) of 49 patients with abnormal vital signs; START (Red, Yellow) only identified 51 percent (35-64 percent). Twenty-one patients needed emergent intervention. ESI (1, 2, 3) identified 95 percent (76-99 percent) of these patients; START (Red, Yellow) identified 33 percent (17-55 percent). ESI (1, 2, 3) identified 98 percent of the 96(92-100 percent) admitted patients; only 48 percent (38-58 percent) were tagged START (Red, Yellow).
Conclusion: ESI better identified patients with abnormal vital signs, those who needed emergent interventions, and those admitted than START.
Robertson-Steel I: Evolution of triage systems. Emerg Med J. 2006; 23: 154-155.
Kahn CA, Schultz CH, Miller KT, et al.: Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009; 54(3): 424-430.
Shelton R: The Emergency Severity Index 5-level triage system. Dimens Crit Care Nurs. 2009; 28(1): 9-12.
McHugh M, Tanabe P, McClelland M, et al.: More patients are triaged using the Emergency Severity Index than any other triage acuity system in the United States. Acad Emerg Med. 2012; 19(1): 106-109.
ESI Triage Research Team, LLC: Appendix B. ESI triage algorithm, version 4. Available at http://www.esitriage.org/algorithm.asp. Accessed January 4, 2015.
Peck JS, Benneyan JC, Nightingale DJ, et al.: Predicting emergency department inpatient admissions to improve same-day patient flow. Acad Emerg Med. 2012; 19: 1045-1054.
Tanabe P, Gimbel R, Yarnold PR, et al.: Reliability and validity of scores on the Emergency Severity Index version 3. Acad Emerg Med. 2004; 11(1): 59-65.
Camilloni L, Rossi PG, Farchi S, et al.: Triage and injury severity scores as predictors of mortality and hospital admission for injuries: a validation study. Accid Anal Prev. 2010; 42: 1958-1965.
van der Wulp I, Schrijvers AJP, van Stel HF: Predicting admission and mortality with the Emergency Severity Index and the Manchester Triage System: A retrospective observational study. Emerg Med J. 2009; 26: 506-509.
Barfod C, Lauritzen MMP, Danker JK, et al.: Abnormal vital signs are strong predictors for intensive care unit admission and inhospital mortality in adults triaged in the emergency department—A prospective cohort study. Scand J Trauma Resusc Emerg Med. 2012; 20: 28-36.
Considine J, Thomas S, Potter R: Predictors of critical care admission in emergency department patients triaged as low to moderate urgency. JAN. 2009; 65(4): 818-827.
Sacco WJ, Navin M, Fiedler KE, et al.: Precise formulation and evidence-based application of resource-constrained triage. Acad Emerg Med. 2005; 12(8): 759-770.
Wuerz RC, Milne LW, Eitel DR, et al.: Reliability and validity of a new five-level triage instrument. Acad Emerg Med. 2000; 7(3): 236-242.
Schenker JD, Goldstein S, Braun J, et al.: Triage accuracy at a multiple casualty incident disaster drill: The emergency medical service, fire department of New York City experience. J Burn Care Res. 2006; 27(5): 570-575.
Sklar DP: Disaster planning and organization: Casualty patters in disasters. J World Assoc Emerg Disaster Med. 1987; 3: 49-51.
Zoraster RM, Chidester C, Koenig W: Field triage and patient maldistribution in a mass-casualty incident. Prehosp Disaster Med. 2007; 22(3): 224-229.
Andrulis DP, Kellermann AL, Hinz EA, et al.: Emergency departments and crowding in United States teaching hospitals. Ann Emerg Med. 1991; 20: 980-986.
Bazarian JJ, Schneider SM, Newman VJ, et al.: Do admitted patients held in the emergency department impact the throughput of treat-and-release patients? Acad Emerg Med. 1996; 3: 1113-1118.
Garner A, Lee A, Harrison K: Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. 2001; 38: 541-548.
Lerner EB, Cone DC, Weinstein ES, et al.: Mass casualty triage: An evaluation of the science and refinement of a national guideline. Disaster Med Public Health Prep. 2011; 5: 129-137.
Risavi BL, Salen PN, Heller MB, et al.: A two-hour intervention using START improves prehospital triage of mass casualty incidents. Prehosp Emerg Care. 2001; 5(2): 197-199.
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