Agreement between caregivers’ assessment of their children’s urgency of illness and the Emergency Severity Index in an urban pediatric emergency department

Purpose:We aimed to evaluate the agreement between caregivers' assessment of their children's urgency of illness and the Emergency Severity Index (ESI) assigned at triage, and to identify factors associated with the caregivers' assessment.Methods: This prospective questionnaire-based study was performed in Department of Pediatric Emergency of Harlem Hospital Center during January-April 2021.Before physician evaluation, caregivers rated perceived urgency of their children's conditions using a 4-level scale (evaluation 15 minutes, 15-59 minutes, 1-2 hours, or >2 hours).ESI levels were assigned by triage nurses.Agreement between the caregivers' assessment and ESI levels was evaluated using intraclass correlation coefficient.Ordinal logistic regression was used to identify factors associated with the caregivers' assessment.Results: A total of 338 caregiver surveys were analyzed.Exact agreement between the caregiver assessment and ESI occurred in 35.8% of cases, with over-and under-triage observed in 54.4% and 9.8%, respectively.The agreement was fair overall (intraclass correlation coefficient, 0.53 95% confidence interval, 0.14-0.72)and good among the caregivers of children with 4 prior visits to emergency departments (0.74 0.16-0.92),non-native English speakers (0.67 0.39-0.81),and daytime presentations (0.64 0.25-0.80).In a regression model, visits in the evenings (adjusted odds ratio, 0.57 0.37-0.88)or nights (0.32 0.15-0.64)and trauma-related visits (0.52 0.30-0.90)were associated with a higher urgency in the caregivers' assessment.Among 15 patients hospitalized to the intensive care unit, 12 were triaged as ESI level 2 and 3 as level 3.The caregivers assessed the former 12 as requiring evaluation within 15 minutes and the latter 3 within 1 hour. Conclusion:Caregiver assessments showed fair agreement and tendency toward over-triage compared with ESI levels.Caregivers' input may provide contextual information but should not replace structured triage systems.