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Table 2 Factors predictive of under-triage to moderate and low ESI acuity levels†

From: Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis

 

Moderate acuity (ESI 3)

Low acuity (ESI 4 or 5)

N = 40,801

N = 31,258

Odds ratio‡ (95% CI)

Odds ratio§ (95% CI)

Age (18–29 years comparator)

 30–49 years

1.25 (1.11–1.41)***

1.15 (1.08–1.22)**

 50–69 years

1.48 (1.3–1.69)***

1.48 (1.33–1.63)**

 ≥ 70 years

1.50 (1.3–1.74)***

2.20 (1.24–3.75)*

Sex (male comparator)

 Female

0.81 (0.75–0.88)***

1.01 (0.95–1.08)

 Null (missing)

0.21 (0.01–0.95)

0.02 (0.00–0.07)**

Temperature (normal comparator)

 Hypothermia (≤ 94.0 °F)

1.15 (0.95–1.39)

0.9 (0.73–1.1)

 Mild hypothermia (94.1–96.2 °F)

1.01 (0.9–1.13)

0.97 (0.88–1.07)

 Mild hyperthermia (99.3–100.4 °F)

0.90 (0.73–1.08)

1.49 (1.33–1.66)**

 Hyperthermic (≥ 100.5 °F)

0.98 (0.77–1.24)

1.65 (1.42–1.9)**

 Null (missing)

1.41 (1.00–1.94)*

1.42 (1.06–1.88)

Heart rate (normal comparator)

 Severe bradycardia (≤ 49 bpm)

2.55 (1.54–4.02)***

0.61 (0.14–1.82)

 Mild bradycardia (50–59 bpm)

1.22 (0.99–1.50)

1.09 (0.85–1.37)

 Mild tachycardia (105–109 bpm)

1.08 (0.88–1.32)

1.2 (1.05–1.37)*

 Moderate tachycardia (110–119 bpm)

1.13 (0.94–1.34)

1.1 (0.98–1.24)

 High tachycardia (120–129 bpm)

1.32 (1.01–1.7)*

1.24 (1.03–1.48)

 Severe tachycardia (≥ 130 bpm)

2.17 (1.61–2.88)***

1.46 (1.1–1.93)*

 Null (missing)

–

1.78 (0.24–12.12)

Systolic blood pressure (normal comparator)

 Hypotension (≤ 99 mmHg)

0.84 (0.70–0.99)*

1.05 (0.89–1.23)

 Mild hypotension (100–107 mmHg)

1.07 (0.88–1.29)

1.15 (1.03–1.28)*

 Mild hypertension (177–199 mmHg)

1.26 (1.03–1.52)*

1.01 (0.6–1.63)

 Hypertension (≥ 200 mmHg)

1.34 (0.78–2.16)

0.78 (0.26–1.88)

 Null (missing)

0.55 (0.23–1.17)

1.65 (1.03–2.56)

Respiratory rate (normal comparator)

 Hypopnea (≤ 13 rpm)

1.59 (0.65–3.29)

0.78 (0.4–1.39)

 Mild hypopnea (14–15 rpm)

1.19 (1.00–1.41)*

1.04 (0.92–1.16)

 Mild tachypnea (20–22 rpm)

0.9 (0.81–0.99)*

1.07 (0.99–1.16)

 Moderate tachypnea (23–27 rpm)

0.83 (0.68–1.00)

1.23 (1.02–1.49)

 Severe tachypnea (≥ 28 rpm)

0.99 (0.56–1.62)

1.38 (0.78–2.36)

 Null (missing)

0.57 (0.06–4.02)

0.14 (0.01–1.24)

Oxygen saturation (normal comparator)

 Severe hypoxia (SpO2 ≤ 89)

2.18 (1.48–3.12)***

1.48 (0.84–2.5)

 Moderate hypoxia (SpO2 90–94)

1.12 (0.97–1.28)

1.10 (0.94–1.29)

 Mild hypoxia (SpO2 95–96)

1.13 (1.00–1.27)*

1.05 (0.95–1.17)

 Null (missing)

2.81 (1.23–5.74)**

2.10 (0.76–5.24)

Pain score (VAS, moderate comparator)

 Mild (0–3)

0.81 (0.73–0.9)***

0.83 (0.77–0.88)**

 Severe [8,9,10]

1.23 (1.11–1.36)***

1.11 (1.01–1.22)

 Null (missing or > 10)

0.47 (0.17–1.04)

0.42 (0.11–1.17)

Chief complaint (general comparator)

 Abdominal pain

1.13 (0.97–1.31)

1.8 (1.57–2.06)**

 Allergic

0.49 (0.27–0.81)*

0.42 (0.30–0.57)**

 Altered mental status

1.55 (0.98–2.36)

1.74 (0.79–3.56)

 Back pain

1.01 (0.81–1.26)

1.47 (1.19–1.82)**

 Chest pain

1.43 (1.17–1.73)***

1.88 (1.54–2.29)**

 Dizziness

0.98 (0.79–1.22)

0.91 (0.74–1.11)

 Dysrhythmia

1.23 (0.79–1.84)

1.22 (0.65–2.14)

 Edema

0.44 (0.29–0.64)***

0.71 (0.54–0.93)

 Ear, nose, and throat

0.88 (0.47–1.50)

0.27 (0.18–0.38)**

 Fever

0.61 (0.48–0.77)***

0.83 (0.72–0.95)*

 Genitourinary

0.69 (0.52–0.9)**

0.95 (0.79–1.14)

 Gastrointestinal bleeding

0.68 (0.36–1.19)

0.73 (0.31–1.48)

 Headache

0.82 (0.67–1.01)

0.75 (0.63–0.88)**

 Hypertension

0.60 (0.28–1.13)

0.92 (0.46–1.69)

 Lower respiratory tract infection

0.36 (0.26–0.47)***

0.76 (0.66–0.88)**

 Musculoskeletal (atraumatic)

0.48 (0.27–0.79)**

0.31 (0.22–0.43)**

 Musculoskeletal (isolated trauma)

0.39 (0.12–0.94)

0.36 (0.09–1.03)

 Neurologic

1.48 (1.17–1.87)***

1.18 (0.82–1.67)

 Nausea, vomiting, and diarrhea

0.57 (0.44–0.73)***

0.84 (0.71–0.99)

 Seizure

0.78 (0.47–1.22)

1.65 (1.08–2.48)

 Shortness of breath

1.06 (0.85–1.32)

1.49 (1.25–1.78)**

 Skin, nails, and hair

0.30 (0.15–0.55)***

0.28 (0.2–0.38)**

 Substance abuse

0.81 (0.24–1.99)

0.59 (0.14–1.76)

 Syncope

1.41 (1.03–1.90)*

1.68 (0.96–2.84)

 Trauma

0.77 (0.59–1.00)

0.70 (0.52–0.92)

 Upper respiratory tract infection

0.44 (0.24–0.75)**

0.26 (0.21–0.32)**

 Weakness

0.78 (0.57–1.05)

0.96 (0.76–1.21)

 Wound

0.35 (0.16–0.66)**

0.45 (0.28–0.68)**

 Other

0.58 (0.39–0.84)**

0.51 (0.38–0.67)**

 Null (missing)

–

0.68 (0.57–0.81)**

Arrival time (17:00–20:59 comparator)

 01:00–07:59

1.23 (1.06–1.44)**

1.77 (1.58–1.99)**

 08:00–12:59

1.48 (1.32–1.67)***

1.75 (1.60–1.90)**

 13:00–16:59

1.20 (1.06–1.36)**

1.37 (1.24–1.50)**

 21:00–00:59

0.91 (0.78–1.06)

1.04 (0.92–1.17)

  1. †Results are odds ratios with 95% confidence intervals in parentheses
  2. bpm beats per minute, rpm respirations per minute, VAS visual analog scale
  3. ‡Odds ratio of being assigned ESI triage level 3 on arrival and subsequently being determined more appropriate for ESI level 1 or 2
  4. §Odds ratio of being assigned ESI triage level 4 or 5 on arrival and subsequently being determined more appropriate for ESI level 1, 2, or 3
  5. *Significant at the 5% level
  6. **Significant at the 1% level
  7. ***Significant at the 0.1% level