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The Emergency Severity Index Version 4: Reliability in Pediatric Patients

Durani, Yamini MD; Brecher, Deena RN, MSN; Walmsley, Daniel MD; Attia, Magdy W. MD; Loiselle, John M. MD

doi: 10.1097/PEC.0b013e3181b0a0c6
Original Articles

Objectives: The Emergency Severity Index version 4 (ESI v.4) is a triage system, which demonstrates reliability in adult populations, however, it has not been extensively studied in pediatrics. The goal of this study was to measure interrater reliability and agreement rates within and between a group of pediatric emergency medicine physicians and pediatric triage (PT) nurses using ESI v.4 in a pediatric population.

Methods: Pediatric emergency medicine physicians and PT nurses completed ESI v.4 training and a survey of 20 pediatric case scenarios, requiring them to assign a triage category to each case. Cases and standardized responses were adapted from the ESI v.4 training materials. Unweighted and weighted κ was measured, and agreement rates for each group were compared with the standard response.

Results: Sixteen physicians and 17 nurses completed the study. The group had a mean of 10.2 (±7.7) years experience in pediatrics. Nurses had a mean of 7.6 (±8.7) years experience in triage. Unweighted κ for physicians and nurses was 0.68 and 0.67, respectively. Weighted κ for physicians and nurses was 0.92 and 0.93, respectively. The agreement rate among physicians and nurses with the standardized responses to case scenarios was 83%.

Conclusions: ESI v.4 is a reliable tool for triage assessments in pediatric patients when used by experienced pediatric emergency medicine physicians and PT nurses. It is a triage system with high agreement between physicians and nurses.

From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Alfred I. duPont Hospital for Children/Thomas Jefferson University, Wilmington, DE.

The original version of this article, published in volume 25, issue 8, has been retracted and replaced with this current version.

Reprints: Yamini Durani, MD, Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19899 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.