Improving Pediatric Emergency Triage: An Assessment of the Emergency Severity Index Using the PECARN Registry (Peds-ESI)

摘要 美国有3400万人在急诊室寻求治疗。虽然紧急 严重程度指数（ESI）是美国最广泛使用的工具，用于优先考虑寻求紧急护理的患者 然而，在包括儿童在内的儿童护理方面，该工具的性能存在重大缺陷。研究表明， 27-40%的患者没有得到适当的分类。不准确的分类与延迟 治疗，过度使用资源，不必要的诊断测试，以及临床护理中的潜在偏见。整体 本项目的目标是改进和提高儿科患者ESI的性能。我们的具体 目标包括： 1.为了评估ESI在正确预测高危患者和资源使用方面的准确性， 具有不同临床和人口统计学特征的多中心艾德人群。 2.探索关键协变量，包括患者人种/种族、医疗复杂性和艾德因素，如 决策支持的存在可能与ESI分类的准确性相关。 我们将使用儿科急诊应用研究对现有数据进行二次分析。 网络（PECARN）注册。PECARN数据库包含来自10个国家的500多万次艾德访问。 医院，包括儿科学术中心和社区附属机构。登记册包括全面的 来自电子健康记录的艾德数据，包括护理和提供者评估、患者生命体征， 护理提供者的订单以及实验室和成像结果。我们的目标与国家儿童研究所一致 健康和人类发展（NICHD）的研究重点，旨在提高安全性和质量， 儿童紧急服务。

Abstract Thirty-four million seek care in emergency departments across the United States. While the Emergency Severity Index (ESI) is the most widely used tool in the US to prioritize care for patients who seek emergency care, including children, there are significant deficiencies in the tool's performance. Studies suggest between 27-40% of patients are not triaged appropriately. Inaccurate triage has been associated with delayed treatment, overuse of resources, unnecessary diagnostic testing, and potential bias in clinical care. The overall objective of this project is to refine and improve the performance of the ESI for pediatric patients. Our specific aims include: 1. To assess the accuracy of the ESI to correctly predict high-risk patients and resource use in a multicenter ED population with diverse clinical and demographic characteristics. 2. To explore key covariates, including patient race/ethnicity, medical complexity, and ED factors such as the presence of decision support that may be associated with the accuracy of triage with ESI. We will perform a secondary analysis of existing data using the Pediatric Emergency Care Applied Research Network (PECARN) Registry. The PECARN database contains more than five million ED visits from 10 hospitals, including pediatric academic centers and community affiliates. The registry includes comprehensive ED data from the electronic health records, including nursing and provider assessments, patient vital signs, care provider orders, and laboratory and imaging results. Our aims align with the National Institute of Child Health and Human Development (NICHD) research priorities that seek to improve the safety and quality of emergency services in children.