Emergency severity index triage category is associated with six-month survival

Objective: The Emergency Severity Index (ESI) is a new five-level triage in strument. The objective of this study was to determine whether there is an association between ESI triage status and short-term survival. Methods: Thi s was a survival analysis for a population-based, stratified random sample of patients over the age of 14 years who visited an urban, university-affil iate hospital emergency department (ED). Measures included ESI triage categ ory (1 through 5), vital status obtained from the Social Security Administr ation, date of death (if applicable), and survival time in days. Data were analyzed with Kaplan-Meier survival analysis. Results: Eighty-seven percent (202/232) of a random sample of patients appeared in the Social Security v ital status registry. During the 252-day follow-up period, 19 patients (9%) died, 161 (80%) lived, and 22 (11%) had an unknown vital status. The ESI t riage level was strongly associated with vital status at six months (Kaplan -Meier chi-square 25.9, p < 0.0001). No patient in triage categories 4 and 5 died (lower limits of the 95% confidence interval for survival, 92% and 9 3%, respectively); whereas survival in triage category 1 was 68%, and in ca tegories 2 and 3 it was 86% and 83%, respectively. Most of the deaths occur red within 60 days after the index ED visit. Sensitivity analyses biased ag ainst the instrument continued to demonstrate the association between triag e status and survival. Conclusions: The ESI triage status is associated wit h six-month survival. Patients with the highest three triage groups experie nced decreased survival during the follow-up period, whereas all patients i n the two lowest triage strata survived at least six months.