Diagnostic test accuracy of the Emergency Severity Index: a systematic review and meta-analysis.

IF 4.2 4区医学 Q1 EMERGENCY MEDICINE

European Journal of Emergency Medicine Pub Date : 2025-10-01 Epub Date: 2025-07-18 DOI:10.1097/MEJ.0000000000001262

Bettina Wandl, Jan D Kellerer, Verena Fuhrmann, Karina Tapinova, Dominik Roth, Gerhard Müller

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引用次数: 0

Abstract

Background and importance: Efficient triage of emergency patients is crucial for the immediate identification of critically ill individuals and enables rapid interventions to improve patient outcomes.

Design: Systematic review and meta-analysis of the diagnostic test accuracy (DTA) of the Emergency Severity Index (ESI) for identifying critically ill adult patients in the emergency department (ED).

Settings and participants: We considered all studies (case-control and cohort studies) that evaluated the DTA of the ESI in adult patients attending an ED. The outcome of a triage system is the high urgency of treatment, commonly used reference standards are short-term mortality or admission to an ICU.

Methods: We searched four bibliographic databases up to 13 February 2025. Screening, inclusion, data extraction, and assessment of methodological quality followed standard Cochrane methodology. We calculated measures of DTA for all studies against the reference standards and calculated pooled estimates using a bivariate random effects model.

Main results: We included 27 studies, representing 510 777 patients. Methodological quality according to the QUADAS-2 tool was high, except for risk of bias in patient selection, which was high for 12 (44%) studies. A total of 18 studies provided data for the reference standard short-term mortality, with an estimated pooled sensitivity of 81.8 [95% confidence interval (CI): 71.8-88.9], specificity of 70.5 (60.5-78.8), diagnostic odds ratio (DOR) of 10.8 (5.4-21.4), positive likelihood ratio of 2.77 (2.02-3.81), and negative likelihood ratio of 0.26 (0.16-0.41). For the reference standard ICU admission, based on 10 studies, pooled estimates were sensitivity of 81.5 (65.2-91.2), specificity of 81.7 (71.9-88.6), DOR of 19.7 (5.5-70.7), positive likelihood ratio of 4.45 (2.58-7.84), and negative likelihood ratio of 0.23 (0.11-0.49). Those results remained stable in the sensitivity analysis.

Conclusion: ESI showed a moderate-to-high diagnostic accuracy for identifying critically ill patients at the ED. These findings support the role of the ESI guided by a principal understanding of the limitations inherent to any triage tool.

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紧急程度指数诊断测试的准确性：一项系统回顾和荟萃分析。

背景和重要性：对急诊患者进行有效的分诊对于立即识别危重患者至关重要，并使快速干预能够改善患者的预后。设计：对急诊科（ED）危重成人患者的急诊严重程度指数（ESI）诊断测试准确性（DTA）进行系统评价和荟萃分析。背景和参与者：我们考虑了所有评估急诊科成年患者ESI DTA的研究（病例对照和队列研究）。分诊系统的结果是治疗的高度紧迫性，常用的参考标准是短期死亡率或入住ICU。方法：检索截至2025年2月13日的4个文献数据库。筛选、纳入、数据提取和方法学质量评估遵循标准Cochrane方法学。我们根据参考标准计算了所有研究的DTA测量值，并使用双变量随机效应模型计算了汇总估计值。主要结果：纳入27项研究，共510777例患者。根据QUADAS-2工具，除了12项（44%）研究的患者选择偏倚风险较高外，方法学质量较高。共有18项研究提供了参考标准短期死亡率的资料，估计合并敏感性为81.8[95%可信区间（CI）： 71.8 ~ 88.9]，特异性为70.5(60.5 ~ 78.8)，诊断优势比（DOR）为10.8(5.4 ~ 21.4)，阳性似然比为2.77(2.02 ~ 3.81)，阴性似然比为0.26（0.16 ~ 0.41）。对于参考标准ICU入院，基于10项研究，合并估计敏感性为81.5(65.2-91.2)，特异性为81.7 (71.9-88.6)，DOR为19.7(5.5-70.7)，阳性似然比为4.45(2.58-7.84)，阴性似然比为0.23（0.11-0.49）。这些结果在敏感性分析中保持稳定。结论：ESI在识别急诊科危重患者方面显示出中高的诊断准确性。这些发现支持ESI在了解任何分诊工具固有局限性的基础上的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Emergency Medicine 医学-急救医学

CiteScore

3.60

自引率

27.30%

发文量

180

审稿时长

6-12 weeks

期刊介绍： The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field. Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.