• Paula Tanabe, Debbie Travers, Nicki Gilboy, Alex Rosenau, Gina Sierzega, Valerie Rupp, Zoran Martinovich, and James G Adams.
• Department of Emergency Medicine, Institute for Health Services Research and Policy Studies, Northwestern University, Chicago, IL, USA. p-tanabe@northwestern.edu
• Acad Emerg Med. 2005 Jun 1;12(6):497-501.

ObjectivesThe Emergency Severity Index (ESI) version 3 is a five-level triage acuity scale with demonstrated reliability and validity. Patients are rated from ESI level 1 (highest acuity) to ESI level 5 (lowest acuity). Clinical experience has demonstrated two levels of ESI level 2 patients: those who require immediate intervention and those who are stable to wait for at least ten minutes. Studies have found that few patients are rated ESI level 1, and it has been suggested that revisions to the ESI might result in appropriate reclassification of some sickest level 2 patients as level 1. The purpose of this study was to identify level 2 patients who might be reclassified as level 1 patients.MethodsThis was a multisite, prospective study. The authors identified ESI level 2 patients who required immediate, lifesaving intervention and calculated chi-square statistics and odds ratios for variables that predicted which ESI level 2 patients actually received immediate intervention.ResultsImmediate lifesaving interventions were provided for 117 (20.2%) of the 589 patients included in the study. Seventeen predictors of the need for immediate intervention were identified. The strongest predictor was the triage nurse's judgment of the need for immediate intervention, especially airway and medications.ConclusionsSpecific clinical findings at triage for a subset of ESI level 2 patients were associated with immediate delivery of lifesaving interventions. Revisions to the ESI level 1 criteria may be beneficial.

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