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A Web-Based Tool for Patient Triage in Emergency Department Settings: Validation Using the Emergency Severity Index.

Elias P, Damle A, Casale M, Branson K, Churi C, Komatireddy R, Feramisco J - JMIR Med Inform (2015)

Bottom Line: Although the ESI and cGPS use different underlying algorithms to calculate patient severity, both utilize a five-point integer scale with level 1 representing the highest severity.Of the 73 case vignettes, the cGPS severity score matched the ESI handbook score in 95% of cases (69/73 cases), in addition, the weighted, quadratic kappa statistic showed almost perfect agreement (kappa = 0.93, 95% CI 0.854-0.996).In the subanalysis of 41 case vignettes assigned ESI scores of level 1 or 2, the cGPS and ESI severity scores matched in 95% of cases (39/41 cases).

View Article: PubMed Central - HTML - PubMed

Affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States. pierre.elias@duke.edu.

ABSTRACT

Background: We evaluated the concordance between triage scores generated by a novel Internet clinical decision support tool, Clinical GPS (cGPS) (Lumiata Inc, San Mateo, CA), and the Emergency Severity Index (ESI), a well-established and clinically validated patient severity scale in use today. Although the ESI and cGPS use different underlying algorithms to calculate patient severity, both utilize a five-point integer scale with level 1 representing the highest severity.

Objective: The objective of this study was to compare cGPS results with an established gold standard in emergency triage.

Methods: We conducted a blinded trial comparing triage scores from the ESI: A Triage Tool for Emergency Department Care, Version 4, Implementation Handbook to those generated by cGPS from the text of 73 sample case vignettes. A weighted, quadratic kappa statistic was used to assess agreement between cGPS derived severity scores and those published in the ESI handbook for all 73 cases. Weighted kappa concordance was defined a priori as almost perfect (kappa > 0.8), substantial (0.6 < kappa < 0.8), moderate (0.4 < kappa < 0.6), fair (0.2 < kappa< 0.4), or slight (kappa < 0.2).

Results: Of the 73 case vignettes, the cGPS severity score matched the ESI handbook score in 95% of cases (69/73 cases), in addition, the weighted, quadratic kappa statistic showed almost perfect agreement (kappa = 0.93, 95% CI 0.854-0.996). In the subanalysis of 41 case vignettes assigned ESI scores of level 1 or 2, the cGPS and ESI severity scores matched in 95% of cases (39/41 cases).

Conclusions: These results indicate that the cGPS is a reliable indicator of triage severity, based on its comparison to a standardized index, the ESI. Future studies are needed to determine whether the cGPS can accurately assess the triage of patients in real clinical environments.

No MeSH data available.


The clinical GPS v2.0 (cGPS) Web-based tool takes clinicians through an 8-step process that supports natural language entry (A) and uses autosuggestions and “quick picks” to maximize efficiency (B).
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figure2: The clinical GPS v2.0 (cGPS) Web-based tool takes clinicians through an 8-step process that supports natural language entry (A) and uses autosuggestions and “quick picks” to maximize efficiency (B).

Mentions: Both the ESI and cGPS utilize a 5-point scale, with 1 representing the highest severity level and 5 representing the lowest. The definitions of each triage score are similar between the ESI and cGPS, and thus were assumed to be roughly equivalent. The 5-point ESI and cGPS scales are detailed in Table 1. The descriptions for the cGPS severity scores were chosen during the initial development of the program. A key difference between the scales is that cGPS allows fractional scores (eg, 4.3) in the preliminary stage. All such fractions were converted to integer values before comparing the scores (see the Study Methodology subsection below; Figure 1 shows the algorithm below and Figure 2 shows the cGPS interface.).


A Web-Based Tool for Patient Triage in Emergency Department Settings: Validation Using the Emergency Severity Index.

Elias P, Damle A, Casale M, Branson K, Churi C, Komatireddy R, Feramisco J - JMIR Med Inform (2015)

The clinical GPS v2.0 (cGPS) Web-based tool takes clinicians through an 8-step process that supports natural language entry (A) and uses autosuggestions and “quick picks” to maximize efficiency (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526930&req=5

figure2: The clinical GPS v2.0 (cGPS) Web-based tool takes clinicians through an 8-step process that supports natural language entry (A) and uses autosuggestions and “quick picks” to maximize efficiency (B).
Mentions: Both the ESI and cGPS utilize a 5-point scale, with 1 representing the highest severity level and 5 representing the lowest. The definitions of each triage score are similar between the ESI and cGPS, and thus were assumed to be roughly equivalent. The 5-point ESI and cGPS scales are detailed in Table 1. The descriptions for the cGPS severity scores were chosen during the initial development of the program. A key difference between the scales is that cGPS allows fractional scores (eg, 4.3) in the preliminary stage. All such fractions were converted to integer values before comparing the scores (see the Study Methodology subsection below; Figure 1 shows the algorithm below and Figure 2 shows the cGPS interface.).

Bottom Line: Although the ESI and cGPS use different underlying algorithms to calculate patient severity, both utilize a five-point integer scale with level 1 representing the highest severity.Of the 73 case vignettes, the cGPS severity score matched the ESI handbook score in 95% of cases (69/73 cases), in addition, the weighted, quadratic kappa statistic showed almost perfect agreement (kappa = 0.93, 95% CI 0.854-0.996).In the subanalysis of 41 case vignettes assigned ESI scores of level 1 or 2, the cGPS and ESI severity scores matched in 95% of cases (39/41 cases).

View Article: PubMed Central - HTML - PubMed

Affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States. pierre.elias@duke.edu.

ABSTRACT

Background: We evaluated the concordance between triage scores generated by a novel Internet clinical decision support tool, Clinical GPS (cGPS) (Lumiata Inc, San Mateo, CA), and the Emergency Severity Index (ESI), a well-established and clinically validated patient severity scale in use today. Although the ESI and cGPS use different underlying algorithms to calculate patient severity, both utilize a five-point integer scale with level 1 representing the highest severity.

Objective: The objective of this study was to compare cGPS results with an established gold standard in emergency triage.

Methods: We conducted a blinded trial comparing triage scores from the ESI: A Triage Tool for Emergency Department Care, Version 4, Implementation Handbook to those generated by cGPS from the text of 73 sample case vignettes. A weighted, quadratic kappa statistic was used to assess agreement between cGPS derived severity scores and those published in the ESI handbook for all 73 cases. Weighted kappa concordance was defined a priori as almost perfect (kappa > 0.8), substantial (0.6 < kappa < 0.8), moderate (0.4 < kappa < 0.6), fair (0.2 < kappa< 0.4), or slight (kappa < 0.2).

Results: Of the 73 case vignettes, the cGPS severity score matched the ESI handbook score in 95% of cases (69/73 cases), in addition, the weighted, quadratic kappa statistic showed almost perfect agreement (kappa = 0.93, 95% CI 0.854-0.996). In the subanalysis of 41 case vignettes assigned ESI scores of level 1 or 2, the cGPS and ESI severity scores matched in 95% of cases (39/41 cases).

Conclusions: These results indicate that the cGPS is a reliable indicator of triage severity, based on its comparison to a standardized index, the ESI. Future studies are needed to determine whether the cGPS can accurately assess the triage of patients in real clinical environments.

No MeSH data available.