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

摘要 3400万人在全美各地的急诊科寻求治疗。在紧急情况下 严重程度指数(ESI)是美国使用最广泛的工具，用于对寻求紧急情况的患者进行优先护理 在护理方面，包括儿童在内，该工具的性能存在重大缺陷。研究表明，在 27%-40%的患者没有得到适当的分诊。不准确的分诊与延误有关 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。整体而言 本项目的目的是改进和提高儿科患者的ESI的性能。我们的特定 目标包括： 1.评估ESI的准确性，以正确预测高危患者和资源使用情况 具有不同临床和人口学特征的多中心ED人群。 2.探索关键的协变量，包括患者种族/民族、医疗复杂性和ED因素，如 决策支持的存在可能与ESI分诊的准确性有关。 我们将使用儿科急救应用研究对现有数据进行二次分析 网络(PECARN)注册表。PECARN数据库包含来自10个国家的500多万ED访问者 医院，包括儿科学术中心和社区附属机构。登记处包括全面的 电子健康记录中的ED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、实验室和成像结果。我们的目标与国家儿童研究所保持一致 健康与人类发展(NICHD)研究优先事项，旨在提高 儿童急救服务。

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.