• María Florencia Grande-Ratti, Jorge Ariel Esteban, Damazo Mongelos, Mario Hernán Díaz, Diego Hernán Giunta, and Bernardo Julio Martínez.
• Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Argentina.
• Rev Med Chil. 2020 May 1; 148 (5): 602-610.

BackgroundUndertriage or the underestimation of the urgency of the condition of a person arriving in an emergency department (ED) represents a measure of quality care.AimTo estimate the prevalence of undertriage in a high complexity hospital of Argentina; to describe characteristics and mortality of these patients.Material And MethodsAll consultations admitted to the ED during 2014 were analyzed. Those assigned to a lower level of admission risk (classified as Emergency Severity Index -ESI- 3 to 5) but required hospitalization in intensive care units (ICU) as the first hospitalization place were considered as an undertriage. A random sample of correctly categorized admissions (ESI 1 or 2), who were subsequently hospitalized in the ICU, was selected as a comparison group.ResultsThe global undertriage prevalence was 0.30% (316/104,832). Among patients admitted to the ICU, the prevalence was 21% (316/1,461; 95% confidence intervals (CI) 19-24). The 316 patients whose severity was underestimated had a median age of 73 years, and admitted between 7 a.m. and 9 p.m. in a greater proportion. Overall hospital mortality was 8.9% (95% CI 6.78-11.38), and all deaths occurred after the patient was transferred from the emergency room. There were no differences in mortality between patients with correct triage or undertriage (11 and 7% respectively, p = 0.09). No differences were observed either in the total number of critical interventions during care in the first 24 hours. Significant differences were observed in requirements for mechanical ventilation (11 and 4% respectively, p = 0.01), orotracheal intubation (10 and 5% respectively p = 0.01) and non-invasive ventilation (8 and 4% respectively, p = 0.05).ConclusionsUndertriage rate in this series was low, but it can be improved.

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