A Web-Based Tool for Patient Triage in Emergency Department Settings: Validation Using the Emergency Severity Index

Pierre Elias, Ash Damle, Michael Casale, Kim Branson, Chaitanya Churi, Ravi Komatireddy, Jamison Feramisco, Pierre Elias, Ash Damle, Michael Casale, Kim Branson, Chaitanya Churi, Ravi Komatireddy, Jamison Feramisco

Abstract

Background: We evaluated the concordance between triage scores generated by a novel Internet clinical decision support tool, Clinical GPS (cGPS) (Lumiata Inc, San Mateo, CA), and the Emergency Severity Index (ESI), a well-established and clinically validated patient severity scale in use today. Although the ESI and cGPS use different underlying algorithms to calculate patient severity, both utilize a five-point integer scale with level 1 representing the highest severity.

Objective: The objective of this study was to compare cGPS results with an established gold standard in emergency triage.

Methods: We conducted a blinded trial comparing triage scores from the ESI: A Triage Tool for Emergency Department Care, Version 4, Implementation Handbook to those generated by cGPS from the text of 73 sample case vignettes. A weighted, quadratic kappa statistic was used to assess agreement between cGPS derived severity scores and those published in the ESI handbook for all 73 cases. Weighted kappa concordance was defined a priori as almost perfect (kappa > 0.8), substantial (0.6 < kappa < 0.8), moderate (0.4 < kappa < 0.6), fair (0.2 < kappa< 0.4), or slight (kappa < 0.2).

Results: Of the 73 case vignettes, the cGPS severity score matched the ESI handbook score in 95% of cases (69/73 cases), in addition, the weighted, quadratic kappa statistic showed almost perfect agreement (kappa = 0.93, 95% CI 0.854-0.996). In the subanalysis of 41 case vignettes assigned ESI scores of level 1 or 2, the cGPS and ESI severity scores matched in 95% of cases (39/41 cases).

Conclusions: These results indicate that the cGPS is a reliable indicator of triage severity, based on its comparison to a standardized index, the ESI. Future studies are needed to determine whether the cGPS can accurately assess the triage of patients in real clinical environments.

Keywords: clinical decision support; differential diagnosis; emergency severity index; triage.

Conflict of interest statement

Conflicts of Interest: JF is Chief Scientific Officer of Lumiata Inc, KB is Chief Data Scientist of Lumiata Inc, AD is Chief Executive Officer of Lumiata Inc, PE is a consultant for Lumiata Inc, NP is an employee of Lumiata Inc, and CC is an employee of Lumiata Inc.

Figures

Figure 1
Figure 1
Overview of the algorithm used to derive the triage score.
Figure 2
Figure 2
The clinical GPS v2.0 (cGPS) Web-based tool takes clinicians through an 8-step process that supports natural language entry (A) and uses autosuggestions and “quick picks” to maximize efficiency (B).
Figure 3
Figure 3
The clinical GPS v2.0 (cGPS) generates differential diagnoses with severity scores and upstream and downstream possibilities, and follow-up questions and tests, including associated costs (C & D).
Figure 4
Figure 4
The clinical GPS v2.0 (cGPS) interfaces directly with the electronic health record (E & F).
Figure 5
Figure 5
Distribution of Emergency Severity Index (ESI) and clinical GPS v2.0 (cGPS) severity scores for the case vignettes (n=73).

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Source: PubMed

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