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Travers DA, Waller AE, Bowling JM, et al. Five-level triage system more effective than three-level in tertiary emergency department. J Emerg Nurs 2002; 28:395-400.
According to this study from the University of North Carolina in Chapel Hill, a new five-level ESI (Emergency Severity Index) triage system is safer and more reliable than the three-level triage system.
Using a random sample of 360 patients, and excluding records with missing or incomplete triage records, the researchers measured the reliability of three-level (3L) triage ratings. The five-level (5L) triage system then was implemented, and the reliability was measured and compared with the three-level group. The study found that under-triage rates were 28% for the 3L system and 12% for the 5L system. Also, less experienced nurses (defined as having fewer than six years of experience) were more likely to under-triage using the 3L system than the 5L system.
"In this study, the 5L [ESI] system was better than the 3L," the researchers report. "The 5L ESI was more reliable, valid, and stable across nurses than the 3L. The 5L system was also safer with regard to under- and over-triage." (For more information on this topic, see "Should you use a 5-level triage scale?" ED Nursing, May 2001, p. 95.)
Keahey L, Bulloch B, Becker AB. Initial oxygen saturation as a predictor of admission in children presenting to the emergency department with acute asthma. Ann Emerg Med 2002; 40:300-307.
Initial oxygen saturation (SaO2) alone isn’t enough to predict whether children presenting to the ED with acute asthma will be admitted, says this multicenter study conducted at Winnepeg Children’s Hospital in Manitoba, Canada, Maricopa Medical Center in Phoenix, and Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.
If initial SaO2 levels accurately predict the need for admission, the time spent in the ED could be decreased, note the researchers, but the study found this was not the case.
The researchers looked at 1,040 children with a documented initial SaO2, and found of these, that 23% (241) were admitted to the hospital. The study found that admission rates did increase as the SaO2 levels decreased, but the researchers concluded it was not possible to identify a cutoff value to reliably predict which children will require admission and which will be discharged home.
Although children with extremely low levels are more likely to be admitted, this applies to only a small subset of children presenting to the ED with acute asthma. "Initial SaO2 does reflect one aspect of an asthma exacerbation, but does not reflect other parameters, such as ventilation-perfusion mismatch or the degree of airway obstruction, nor can it predict the child’s response to therapy," the researchers wrote.