Association Between Triage Score and Resource Use for Children Presenting to the Emergency Department with Behavioral Health Conditions

Objective Among pediatric emergency department (ED) visits for behavioral health (BH), we examined the association between Emergency Severity Index (ESI) level and (1) the time to first provider evaluation and (2) ED resource use. Methods This retrospective cross-sectional study, using the National Hospital Ambulatory Medical Care Survey, assessed ED visits of children aged 5 to 17 years. For each ESI level, we compared resource use among BH versus non-BH visits. Among BH visits, regression models examined the association of ESI level and (1) the time to first provider evaluation and (2) ED resource use, adjusted for visit characteristics. Results There were an estimated 3,646,060 pediatric BH ED visits and 52,499,554 non-BH ED visits. Across all visits with ESI 4 to 5 (least acute), BH visits were more likely to use >1 resource (32.1%) compared with non-BH visits (15.6%; difference 16.5%, 95% confidence interval [CI] 2.0 to 30.9). Among BH visits, the most frequent ESI level was 1 to 2 (most acute; 48.5%); of these, 57.8% resulted in discharge/other disposition. Among BH visits, ESI was not associated with time to first provider evaluation; the estimated incidence rate ratio for number of different resources used was 1.59 (95% CI 1.18 to 2.14) for ESI 1 to 2 and 1.37 (95% CI 1.02 to 1.85) for ESI 3 compared with ESI 4 to 5. Conclusions Among pediatric BH ED visits, ESI level was associated with ED resource use, but not time to first provider evaluation. Many high acuity BH visits resulted in discharge, whereas one third of low acuity BH visits required >1 resource, suggesting misalignment of assigned ESI levels with resource use.