Evaluation of the Significance of Vital Signs in the Up-Triage of Patients Visiting Emergency Department from Emergency Severity Index Level 3 to 2

Abstract

The Emergency Severity Index (ESI) is a five-level triage system that has shown promising reliability and validity. According to ESI algorithm, in the presence of danger zone respiratory rate (RR), heart rate (HR) or Oxygen (O2) saturation, patients should be up-triaged from ESI level 3 to 2 Hence, the current study aimed to investigate the value of the measurement of vital signs in predicting the up-triage of patients from ESI level 3 to 2. Patients who visited the emergency department at Imam Khomeini Hospital Complex, Tehran, Iran, and were categorized into ESI level 3 were investigated. RR, HR, and O2 saturation were recorded by the triage nurse, and the rates of abnormalities in these three variables were evaluated. Out of 551 cases who were up-triaged from ESI level 3 to 2,489 (88.7%) had an increased RR, and 539 (97.8%) had an increased RR or HR. Only 12 cases (2.2%) had normal RR and HR, who were up-triaged only due to abnormal O2 saturation. Out of these 12 cases, 10 had O2 saturations <92% at common health status, 1 had acutely altered mental status and should have been triaged into ESI level 2 in the first place and 1 could not be located for further investigations. In conclusion, compared to O2 saturation, the abnormal findings during the assessment of RR and HR seem to much more commonly result in the up-triage of patients from ESI level 3 to 2.

Keywords: Emergency medicine; Heart rate; Oximetry; Respiratory rate; Triage.