@Article{info:doi/10.2196/medinform.3508,
author="Elias, Pierre
and Damle, Ash
and Casale, Michael
and Branson, Kim
and Peterson, Nick
and Churi, Chaitanya
and Komatireddy, Ravi
and Feramisco, Jamison",
title="A Web-Based Tool for Patient Triage in Emergency Department Settings: Validation Using the Emergency Severity Index",
journal="JMIR Med Inform",
year="2015",
month="Jun",
day="10",
volume="3",
number="2",
pages="e23",
keywords="triage; emergency severity index; differential diagnosis; clinical decision support",
abstract="Background: We evaluated the concordance between triage scores generated by a novel Internet clinical decision support tool, Clinical GPS (cGPS) (Lumiata Inc, San Mateo, CA), and the Emergency Severity Index (ESI), a well-established and clinically validated patient severity scale in use today.  Although the ESI and cGPS use different underlying algorithms to calculate patient severity, both utilize a five-point integer scale with level 1 representing the highest severity. Objective: The objective of this study was to compare cGPS results with an established gold standard in emergency triage. Methods: We conducted a blinded trial comparing triage scores from the ESI: A Triage Tool for Emergency Department Care, Version 4, Implementation Handbook to those generated by cGPS from the text of 73 sample case vignettes. A weighted, quadratic kappa statistic was used to assess agreement between cGPS derived severity scores and those published in the ESI handbook for all 73 cases. Weighted kappa concordance was defined a priori as almost perfect (kappa > 0.8), substantial (0.6 < kappa < 0.8), moderate (0.4 < kappa < 0.6), fair (0.2 < kappa< 0.4), or slight (kappa < 0.2). Results: Of the 73 case vignettes, the cGPS severity score matched the ESI handbook score in 95{\%} of cases (69/73 cases), in addition, the weighted, quadratic kappa statistic showed almost perfect agreement (kappa = 0.93, 95{\%} CI 0.854-0.996).  In the subanalysis of 41 case vignettes assigned ESI scores of level 1 or 2, the cGPS and ESI severity scores matched in 95{\%} of cases (39/41 cases). Conclusions: These results indicate that the cGPS is a reliable indicator of triage severity, based on its comparison to a standardized index, the ESI.  Future studies are needed to determine whether the cGPS can accurately assess the triage of patients in real clinical environments. ",
issn="2291-9694",
doi="10.2196/medinform.3508",
url="http://medinform.jmir.org/2015/2/e23/",
url="https://doi.org/10.2196/medinform.3508"
}