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

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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.