Abstract
Objective The Emergency Severity Index (ESI) version 4 is a 5-level triage system (1 being
the highest acuity and 5 being the lowest acuity) used in the emergency department
(ED). Our goal of the study was to compare rates of readmission according to ESI in
postpartum women.
Study Design This was a secondary analysis of a retrospective cohort study of all women who presented
to the ED within 6 weeks after cesarean delivery. The acuity level was assigned by
triage nurses at the time of triage presentation. Our primary outcome was postpartum
readmission. To examine if the addition of blood pressure to vital sign abnormalities
would improve the prediction for readmission, we created a modified ESI. We identified
women who had an ESI of level 3 and reassigned to a modified ESI of level 2 if blood
pressure was in the severe range. Receiver operating characteristic curves with area
under the curve (AUC) were created and compared between ESI and modified ESI.
Results Of 439 women, ESI distribution was 0.2% ESI 1, 23.7% ESI 2, 56.0% ESI 3, 19.4% ESI
4, and 0.7% ESI 5. Readmission rates by ESI level were 100% ESI 1, 47% ESI 2, 18%
ESI 3, 2% ESI 4, and 0% ESI 5 (p < 0.001). Of 246 women who were assigned an ESI of 3, total 25 had severe range blood
pressures and were reassigned to a modified ESI of 2. Of these 25 women, 14 were readmitted.
The AUC of the modified ESI was statistically higher than that of the standard ESI
(AUC: 0.77 and 95% confidence interval: 0.72–0.82 vs. AUC: 0.73 and 95% confidence
interval: 0.68–0.78; p < 0.01).
Conclusion The ESI was a useful tool to identify women who required postpartum readmission.
Incorporation of severe range blood pressure as a parameter of acuity improved the
prediction of readmission.
Key Points
-
ESI does not consider blood pressure.
-
The ESI version 4 was predictive of postpartum readmission.
-
Consideration of a severe range blood pressure significantly improved the prediction
of readmission.
Keywords
blood pressure - resource use - time-efficient care - triage
