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Table 3 Factors predictive of over-triage to high and moderate 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

 

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 [8,9,10]

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)***

  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 1 or 2 on arrival and subsequently being determined more appropriate for ESI level 3, 4, or 5
  4. §Odds ratio of being assigned ESI triage level 3 on arrival and subsequently being determined more appropriate for ESI level 4 or 5
  5. *Significant at the 5% level
  6. **Significant at the 1% level
  7. ***Significant at the 0.1% level
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International Journal of Emergency Medicine

ISSN: 1865-1380

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