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A Comparison of Parental and Nursing Assessments of Level of Illness or Injury in a Pediatric Emergency Department

Background: The 5-tier Emergency Severity Index (ESI) score is a well-accepted, validated triage tool with good interrater reliability. Parental perception of illness severity has not been compared to ESI score. Objective: This study compares parental assessment of severity of illness to triage nurse acuity. Design: Prospective and descriptive. Setting: Large, urban pediatric emergency department (ED). Participants: Parents/guardians of patients younger than 18 years. Intervention: The triage nurse assigned an ESI score, and the parent/guardian assigned all patients a severity score on a scale of 1 to 5 (1, most sick and 5, least sick). Mean severity scores were compared between the groups. Results: There were 142 participants with a mean patient age of 6.15 years. The mean participant and nurse severity scores were 3.01 and 3.35, respectively, with an intraclass correlation coefficient of 0.203 (P = 0.008). Most frequently, the parent/guardian and triage nurse assigned the same score (n = 44, 31%). Seventy-six percent of the parent/guardian scores were within 1 point of the triage nurse score. Conclusions: Close agreement exists between parent/guardian and nurse ESI scores, illustrating objectivity in parent/guardian assessments. This study provides a springboard for future studies regarding ED use after educating families on ED triage.