Table 3.
Factors predictive of over-triage to high and moderate ESI acuity levels†
| High acuity (ESI 1 or 2) | Moderate acuity (ESI 3) | |
|---|---|---|
| N = 17,606 | N = 44,470 | |
| Odds ratio‡ (95% CI) | Odds ratio§ (95% CI) | |
| Age (18–29 years comparator) | ||
| 30–49 years | 0.80 (0.68, 0.93)** | 0.79 (0.73,0.84)*** |
| 50–69 years | 0.62 (0.52, 0.74)*** | 0.65 (0.6–0.71)*** |
| ≥ 70 years | 0.37 (0.31, 0.46)*** | 0.42 (0.37–0.46)*** |
| Sex (male comparator) | ||
| Female | 1.40 (1.24–1.57)*** | 1.12 (1.06–1.19)*** |
| Null (missing) | – | 0.68 (0.26–1.49) |
| Temperature (normal comparator) | ||
| Hypothermia (≤ 94.0 °F) | 0.80 (0.63, 1.01) | 1.05 (0.97–1.14) |
| Mild hypothermia (94.1–96.2 °F) | 1.00 (0.86, 1.17) | 1.03 (0.89–1.19) |
| Mild hyperthermia (99.3–100.4 °F) | 0.99 (0.73, 1.33) | 0.81 (0.71–0.92)** |
| Hyperthermic (≥ 100.5 °F) | 1.28 (0.89, 1.79) | 0.66 (0.54–0.79)*** |
| Null (missing) | 0.68 (0.40, 1.09) | 0.93 (0.71–1.19) |
| Heart rate (normal comparator) | ||
| Severe bradycardia (≤ 49 bpm) | 0.46 (0.19, 0.91)* | 0.75 (0.39–1.31) |
| Mild bradycardia (50–59 bpm) | 1.11 (0.83, 1.46) | 0.99 (0.83–1.17) |
| Mild tachycardia (105–109 bpm) | 0.83 (0.61, 1.11) | 0.89 (0.78–1.03) |
| Moderate tachycardia (110–119 bpm) | 0.84 (0.66, 1.05) | 0.97 (0.86–1.09) |
| High tachycardia (120–129 bpm) | 0.83 (0.61, 1.11) | 0.94 (0.78–1.13) |
| Severe tachycardia (≥ 130 bpm) | 0.35 (0.23, 0.51)*** | 0.88 (0.67–1.14) |
| Null (missing) | 0.49 (0.05, 4.48) | 1.23 (0.22–6.74) |
| Systolic blood pressure (normal comparator) | ||
| Hypotension (≤ 99 mmHg) | 0.71 (0.55, 0.91)** | 0.85 (0.73–0.97)* |
| Mild hypotension (100–107 mmHg) | 1.04 (0.82, 1.3) | 0.95 (0.86–1.06) |
| Mild hypertension (177–199 mmHg) | 0.94 (0.75, 1.17) | 0.78 (0.65–0.92)** |
| Hypertension (≥ 200 mmHg) | 1.02 (0.75, 1.38) | 0.99 (0.63–1.48) |
| Null (missing) | 1.89 (1.04, 3.22)* | – |
| Respiratory rate (normal comparator) | ||
| Hypopnea (≤ 13 rpm) | 0.00 (0.00, 0.01) | 1.11 (0.56–2.01) |
| Mild hypopnea (14–15 rpm) | 0.77 (0.57, 1.03) | 1.04 (0.92–1.18) |
| Mild tachypnea (20–22 rpm) | 1.05 (0.92, 1.19) | 1.04 (0.97–1.11) |
| Moderate tachypnea (23–27 rpm) | 0.96 (0.78, 1.17) | 0.87 (0.76–1.00)* |
| Severe tachypnea (≥ 28 rpm) | 0.75 (0.47, 1.14) | 0.79 (0.49–1.22) |
| Null (missing) | 2.84 (0.35, 14.23) | 0.80 (0.11–4.28) |
| Oxygen saturation (normal comparator) | ||
| Severe hypoxia (SpO2 ≤ 89) | 0.40 (0.25, 0.62)*** | 0.85 (0.55–1.25) |
| Moderate hypoxia (SpO2 90–94) | 0.72 (0.59, 0.88)** | 0.62 (0.55–0.7)*** |
| Mild hypoxia (SpO2 95–96) | 0.81 (0.67, 0.97)* | 0.86 (0.78–0.94)*** |
| Null (missing) | 0.31 (0.05, 1.2) | 0.67 (0.21–1.68) |
| Pain score (VAS, moderate comparator) | ||
| Mild (0–3) | 0.80 (0.68, 0.95)* | 0.86 (0.78–0.94)*** |
| Severe [8–10] | 0.79 (0.68, 0.93)** | 0.85 (0.55–1.25) |
| Null (missing or > 10) | 0.23 (0.06, 0.67)* | 0.67 (0.21–1.68) |
| Chief complaint (general comparator) | ||
| Abdominal pain | 0.84 (0.67, 1.06) | 0.77 (0.69–0.87)*** |
| Allergic | 2.14 (1.33, 3.34)** | 1.96 (1.57–2.45)*** |
| Altered mental status | 0.63 (0.30, 1.17) | 0.36 (0.16–0.69)** |
| Back pain | 0.83 (0.61, 1.11) | 1.08 (0.91–1.27) |
| Chest pain | 1.04 (0.78, 1.4) | 0.68 (0.57–0.81)*** |
| Dizziness | 1.36 (0.97, 1.89) | 1.13 (0.96–1.32) |
| Dysrhythmia | 1.31 (0.72, 2.24) | 1.00 (0.72–1.38) |
| Edema | 1.33 (0.7, 2.33) | 1.37 (1.12–1.67)** |
| Ear, nose, and throat | 1.67 (0.88, 2.97) | 2.67 (1.99–3.55)*** |
| Fever | 1.52 (1.01, 2.25)* | 0.94 (0.81–1.10) |
| Genitourinary | 1.23 (0.81, 1.81) | 1.08 (0.90–1.28) |
| Gastrointestinal bleeding | 1.04 (0.53, 1.88) | 1.06 (0.73–1.51) |
| Headache | 1.21 (0.92, 1.58) | 1.38 (1.21–1.58)*** |
| Hypertension | 2.00 (1.02, 3.67)* | 1.88 (1.29–2.66)*** |
| Lower respiratory tract infection | 2.15 (1.28, 3.49)** | 1.43 (1.23–1.66)*** |
| Musculoskeletal (atraumatic) | 1.62 (0.83, 2.92) | 2.21 (1.76–2.77)*** |
| Musculoskeletal (isolated trauma) | 1.02 (0.24, 2.91) | 0.70 (0.36–1.24) |
| Neurologic | 1.13 (0.84, 1.52) | 0.79 (0.64–0.96)* |
| Nausea, vomiting, and diarrhea | 1.37 (0.99, 1.88) | 1.33 (1.15–1.54)*** |
| Seizure | 0.85 (0.48, 1.41) | 0.77 (0.53–1.08) |
| Shortness of breath | 1.33 (0.96, 1.82) | 0.89 (0.75–1.06) |
| Skin, nails, and hair | 1.65 (0.77, 3.21) | 2.32 (1.88–2.87)*** |
| Substance abuse | 2.11 (0.76, 4.97) | 0.45 (0.14–1.11) |
| Syncope | 0.69 (0.45, 1.03) | 0.75 (0.56–0.98)* |
| Trauma | 0.92 (0.65, 1.30) | 0.89 (0.73–1.07) |
| Upper respiratory tract infection | 2.11 (0.70, 5.24) | 2.82 (2.27–3.5)*** |
| Weakness | 1.71 (1.13, 2.54)** | 1.36 (1.12–1.65)** |
| Wound | 0.64 (0.22, 1.48) | 1.58 (1.2–2.06)*** |
| Other | 0.94 (0.59, 1.44) | 1.39 (1.14–1.69)** |
| Null (missing) | 1.02 (0.79, 1.31) | 1.00 (0.87–1.14) |
| Arrival time (17:00–20:59 comparator) | ||
| 01:00–07:59 | 1.02 (0.83, 1.25) | 0.84 (0.76–0.94)** |
| 08:00–12:59 | 1.37 (1.17, 1.61)*** | 1.23 (1.14–1.33)*** |
| 13:00–16:59 | 1.21 (1.02, 1.43)* | 1.07 (0.99–1.16) |
| 21:00–00:59 | 0.99 (0.82, 1.19) | 0.76 (0.69–0.84)*** |
†Results are odds ratios with 95% confidence intervals in parentheses
bpm beats per minute, rpm respirations per minute, VAS visual analog scale
‡Odds ratio of being assigned ESI triage level 1 or 2 on arrival and subsequently being determined more appropriate for ESI level 3, 4, or 5
§Odds ratio of being assigned ESI triage level 3 on arrival and subsequently being determined more appropriate for ESI level 4 or 5
*Significant at the 5% level
**Significant at the 1% level
***Significant at the 0.1% level