Document Type : Original Article


Department of Emergency Medicine, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences (RGUHS), Bangalore, Karnataka, India


Objective:To implement the 5-level Emergency Severity Index (ESI) triage tool into nursing
practice in the emergency department (ED) and validate it with a population-based cohort
using hospitalization and length of stay (LOS) as outcome measures.
Methods: The study included 850 patients, irrespective of age and gender, reporting to
the ED of a tertiary care hospital. Each patient was assessed by the triage nurse as per
the 5-level ESI triage tool and categorized. The number and type of resources used by the
patient, LOS in the ED and the outcome were noted. Data were statistically analyzed by
using RStudio Team software, 2015. A P value of < 0.05 was considered to be statistically
Results: The majority of patients belonged to ESI-4 (46.82%), followed by ESI-1 (19.41%),
ESI-2 (17.06%), ESI-3 (10.35%), and ESI-5 (6.35%). In most patients, the LOS in the ED was
<120 minutes (55.65%). ESI showed a statistically significant association with all the clinical
characteristics, as well as resources used, interventions needed, maximum time allowed
before initiating physician assessment, duration of stay in ED, and patient outcomes
(P=0.000). ESI was found to have a sensitivity of 100% and specificity of 78%.
Conclusion: ESI is a useful and valid tool for the emergency triage and has the potential to
become the standard triage acuity assessment in EDs in India.


Main Subjects

  1. Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument.
    Acad Emerg Med 2000; 7(3): 236-42. doi: 10.1111/j.1553-2712.2000.tb01066.x.
    2. Gilboy N, Tanabe T, Travers D, Rosenau AM. Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4. Implementation Handbook .2012 Edition. AHRQ Publication No. 12-0014. Rockville,MD: Agency for Healthcare Research and Quality (AHRQ); 2011.
    3. Wuerz R, Fernandes CM, Alarcon J. Inconsistency of emergency department triage. Emergency Department Operations Research Working Group. Ann Emerg Med 1998; 32(4): 431-5. doi: 10.1016/s0196-0644(98)70171-4.
    4. Brillman JC, Doezema D, Tandberg D, Sklar DP, Davis KD, Simms S, et al. Triage: limitations in predicting need for
    emergent care and hospital admission. Ann Emerg Med 1996; 27(4): 493-500. doi: 10.1016/s0196-0644(96)70240-8.
    5. Travers DA, Waller AE, Bowling JM, Flowers D, Tintinalli J. Five-level triage system more effective than three-level in
    tertiary emergency department. J Emerg Nurs 2002; 28(5): 395-400. doi: 10.1067/men.2002.127184.
    6. Eitel DR, Travers DA, Rosenau AM, Gilboy N, Wuerz RC. The emergency severity index triage algorithm version 2 is
    reliable and valid. Acad Emerg Med 2003; 10(10): 1070-80. doi: 10.1111/j.1553-2712.2003.tb00577.x.
    7. Worster A, Gilboy N, Fernandes CM, Eitel D, Eva K, Geisler R, et al. Assessment of inter-observer reliability of two fivelevel triage and acuity scales: a randomized controlled trial. CJEM 2004; 6(4): 240-5. doi: 10.1017/s1481803500009192.
    8. Wuerz R. Emergency severity index triage category is associated with six-month survival. ESI Triage Study Group. Acad Emerg Med 2001; 8(1): 61-4. doi: 10.1111/j.1553-2712.2001.tb00554.x.
    9. Singer RF, Infante AA, Oppenheimer CC, West CA, Siegel B. The use of and satisfaction with the Emergency Severity Index. J Emerg Nurs 2012; 38(2): 120-6. doi: 10.1016/j.jen.2010.07.004.
  2. 10. Travers DA, Waller AE, Katznelson J, Agans R. Reliability and validity of the emergency severity index for pediatric triage. Acad Emerg Med 2009; 16(9): 843-9. doi:10.1111/j.1553-2712.2009.00494.x.
    11. Durani Y, Brecher D, Walmsley D, Attia MW, Loiselle JM. The Emergency Severity Index version 4: reliability in
    pediatric patients. Pediatr Emerg Care 2009; 25(11): 751-3.
    12. Baumann MR, Strout TD. Triage of geriatric patients in the emergency department: validity and survival with the Emergency Severity Index. Ann Emerg Med 2007; 49(2): 234-40. doi: 10.1016/j.annemergmed.2006.04.011.
    13. Platts-Mills TF, Travers D, Biese K, McCall B, Kizer S, LaMantia M, et al. Accuracy of the Emergency Severity
    Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving
    intervention. Acad Emerg Med 2010; 17(3): 238-43. doi:10.1111/j.1553-2712.2010.00670.x.
    14. Baumann MR, Strout TD. Evaluation of the Emergency Severity Index (version 3) triage algorithm in pediatric
    patients. Acad Emerg Med 2005; 12(3): 219-24. doi:10.1197/j.aem.2004.09.023.
    15. Tanabe P, Gimbel R, Yarnold PR, Kyriacou DN, Adams JG. Reliability and validity of scores on The Emergency Severity Index version 3. Acad Emerg Med 2004; 11(1): 59-65. doi:10.1197/j.aem.2003.06.013.
    16. Elshove-Bolk J, Mencl F, van Rijswijck BT, Simons MP, van Vugt AB. Validation of the Emergency Severity Index
    (ESI) in self-referred patients in a European emergency department. Emerg Med J 2007; 24(3): 170-4. doi: 10.1136/emj.2006.039883.
    17. Chi CH, Huang CM. Comparison of the Emergency Severity Index (ESI) and the Taiwan Triage System in predicting resource utilization. J Formos Med Assoc 2006; 105(8): 617-25. doi: 10.1016/s0929-6646(09)60160-1.