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Validation of the Emergency Severity Index (ESI) in self-referred patients in a European emergency department
  1. Jolande Elshove-Bolk1,
  2. Francis Mencl2,
  3. Bas T F van Rijswijck3,
  4. Maarten P Simons2,
  5. Arie B van Vugt3
  1. 1Department of Anaesthesiology, Haukeland University Hospital, Bergen, Norway
  2. 2Department of Emergency Medicine, OLVG, Amsterdam, The Netherlands
  3. 3Universiteit van Maastricht, Maastricht, The Netherlands
  4. 4Department of Traumatology, Academisch Ziekenhuis Nijmegen, Nijmegen, The Netherlands
  1. Correspondence to:
 Dr J Elshove-Bolk
 Department of Anaesthesiology, Haukeland University Hospital, Bergen N-5021, Norway; jhwelshove{at}


Objective: To validate the Emergency Severity Index (ESI) triage algorithm in predicting resource consumption and disposition by self-referred patients in a European emergency department.

Methods: This was a prospective, observational cohort study using a convenience sample of self-referred emergency department patients >14 years of age presenting to a busy urban teaching hospital during a 39-day period (27 May–4 July 2001). Observed resource use was compared with resource utilisation predicted by the ESI. Outpatient referrals after discharge and hospitalisations were also recorded.

Results: ESI levels were obtained in 1832/3703 (50%) self-referred patients, most of whom were in the less severe ESI-4 (n = 685, 37%) and ESI-5 (n = 983, 54%) categories. Use of resources was strongly associated with the triage level, rising from 15% in ESI-5 to 97% in ESI-2 patients. Specialty consultations and admissions also rose with increasing ESI severity. Only 5% of ESI-5 patients required consultation and <1% were admitted, whereas 85% of ESI-2 patients received a consultation and 56% were admitted, 26% to a critical care bed. Only 2% of the ESI-5 patients underwent blood tests, compared with 76% of the sicker ESI-2 patients. x Rays were the most commonly used resource in patients triaged to ESI-4 and ESI-5.

Conclusion: The ESI triage category reliably predicts the severity of a patient’s condition, as reflected by resource utilisation, consultations and admissions in a population of self-referred patients in a European emergency department. It clearly identifies patients who require minimal resources, or at most an x ray, and those unlikely to require admission.

  • ECG, electrocardiogram
  • ESI, Emergency Severity Index

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  • Competing interests: None declared.