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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) interfaces directly with the electronic health record (E & F).
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figure4: The clinical GPS v2.0 (cGPS) interfaces directly with the electronic health record (E & F).

Mentions: For each case vignette, the ESI handbook provides a severity score that was obtained using the ESI triage methodology. Vignette topics cover a wide array of potential pathologies and severities. The ESI handbook does not list specific differential diagnoses for each vignette, nor do the vignettes present objective laboratory data; however, all vignettes include the patient’s age, gender, and at least one sign or symptom. Whenever present, patient’s complaints, past medical history, vital signs, and physical exam values were entered into the cGPS program exactly as written in the handbook. The narrative nature of the handbook vignettes was compatible with the cGPS user interface that allows users to input core information in a format similar to the history and physical note that physicians commonly use to document care (Figures 2 and 4 show the interface). Thus, for each ESI vignette, the data available in the handbook were entered directly into the cGPS tool, and the cGPS algorithm then generated a triage score.


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) interfaces directly with the electronic health record (E & F).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

figure4: The clinical GPS v2.0 (cGPS) interfaces directly with the electronic health record (E & F).
Mentions: For each case vignette, the ESI handbook provides a severity score that was obtained using the ESI triage methodology. Vignette topics cover a wide array of potential pathologies and severities. The ESI handbook does not list specific differential diagnoses for each vignette, nor do the vignettes present objective laboratory data; however, all vignettes include the patient’s age, gender, and at least one sign or symptom. Whenever present, patient’s complaints, past medical history, vital signs, and physical exam values were entered into the cGPS program exactly as written in the handbook. The narrative nature of the handbook vignettes was compatible with the cGPS user interface that allows users to input core information in a format similar to the history and physical note that physicians commonly use to document care (Figures 2 and 4 show the interface). Thus, for each ESI vignette, the data available in the handbook were entered directly into the cGPS tool, and the cGPS algorithm then generated a triage score.

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.