• Ru Ying Fong, Wee Sern Sim Glen, Ahmad Khairil Mohamed Jamil, Tam Wilson Wai San WWS Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore., and Yanika Kowitlawakul.
• Department of Emergency Medicine, Sengkang General Hospital, Sengkang Health, Singapore. Electronic address: fong.ru.ying@skh.com.sg.
• Int Emerg Nurs. 2018 Nov 1; 41: 13-18.

ObjectivesTo compare the reliability, validity and resource utilization of the Emergency Severity Index (ESI) and Patient Acuity Category Scale (PACS) triage scales.MethodsA descriptive, correlational, and cross-sectional design was used. Twenty-seven triage nurses were recruited to test interrater reliability for 20 patient case scenarios. Subsequently, interrater reliability was tested on 300 actual patients. Construct validity was analyzed using patients' hospital dispositions and resources utilized.ResultsFor patient case scenarios, interrater reliability for both were very good, at 0.87 (95% CI: 0.86-0.88) for ESI and 0.88 (95% CI: 0.87-0.89) for PACS. For actual patients, interrater reliability for both were moderate, at 0.59 (95% CI: 0.50-0.68) for ESI and 0.49 (95% CI: 0.40-0.60) for PACS. Both ESI and PACS demonstrated construct validity with moderate correlations for hospital admissions and the number of resources used. PACS was unable to discriminate between patients that required more or less resources, whereas the ESI can. Patients that required two or more resources had higher rates of admission.ConclusionsBoth triage systems demonstrated moderate interrater reliability and construct validity in triaging actual patients. The ESI has better resource discrimination ability than the PACS and can improve resource management in the ED.Copyright © 2018 Elsevier Ltd. All rights reserved.

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