Pediatric Triage Accuracy in Pediatric and General Emergency Departments

BACKGROUND AND OBJECTIVES: Accurate triage at the time of emergency department (ED) presentation is critical for timely acuity assessment and anticipating resource requirements. Commonly, triage is conducted using the Emergency Severity Index (ESI); however, the accuracy of this approach for children in general EDs is uncertain. The purpose of this study was to quantify pediatric triage accuracy in a national sample of ED visits and evaluate whether presentation to a pediatric vs general ED is associated with mistriage. METHODS: This was a cross-sectional study of the 2017-2021 National Hospital Ambulatory Medical Care Survey of pediatric (aged <18 years) ED visits with an ESI score from 3 to 5. The outcome was mistriage (resource utilization discordant with ESI prediction). Standardized ESI definitions were applied to count resources. We used multivariable logistic regression to evaluate whether presentation to a pediatric or general ED was associated with triage accuracy. RESULTS: Of 149 million visits, mistriage occurred in 53.7% of ESI 3, 57.7% of ESI 4, and 22.9% of ESI 5 visits. Children in general EDs were more likely to be mistriaged than children in pediatric EDs (adjusted odds ratio OR, 1.29; 95% CI, 1.11-1.50). Young age was associated with mistriage (aged <1 year vs aged 13-17: adjusted OR 95% CI, 2.42 2.00-2.94, 1-5 years: 1.79 1.53-2.10, 6-12 years: 1.38 1.16-1.64). CONCLUSION: Mistriage was common among children with an initial ESI of 3 to 5 and more common among children visiting general EDs. Our findings highlight the need for improved resource prediction at the time of triage.