Selected Topics: Oncological Emergencies| Volume 57, ISSUE 3, P354-361, September 2019

Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients With Active Cancer



      Patients with active cancer account for a growing percentage of all emergency department (ED) visits and have a unique set of risks related to their disease and its treatments. Effective triage for this population is fundamental to facilitating their emergency care.


      We evaluated the validity of the Emergency Severity Index (ESI; version 4) triage tool to predict ED-relevant outcomes among adult patients with active cancer.


      We conducted a prespecified analysis of the observational cohort established by the National Cancer Institute–supported Comprehensive Oncologic Emergencies Research Network’s multicenter (18 sites) study of ED visits by patients with active cancer (N = 1075). We used a series of χ2 tests for independence to relate ESI scores with 1) disposition, 2) ED resource use, 3) hospital length of stay, and 4) 30-day mortality.


      Among the 1008 subjects included in this analysis, the ESI distribution skewed heavily toward high acuity (>95% of subjects had an ESI level of 1, 2, or 3). ESI was significantly associated with patient disposition and ED resource use (p values < 0.05). No significant associations were observed between ESI and the non-ED based outcomes of hospital length of stay or 30-day mortality.


      ESI scores among ED patients with active cancer indicate higher acuity than the general ED population and are predictive of disposition and ED resource use. These findings show that the ESI is a valid triage tool for use in this population for outcomes directly relevant to ED care.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gilboy N.
        • Tanabe P.
        • Travers D.
        • Rosenau A.M.
        Emergency Severity Index (ESI): A triage tool for emergency department care version 4 implementation handbook 2012 edition. AHRQ publication no. 12-0014.
        Agency for Healthcare Research and Quality, Rockville, MD2011
        • Wuerz R.C.
        • Milne L.W.
        • Eitel D.R.
        • Travers D.
        • Gilboy N.
        Reliability and validity of a new five-level triage instrument.
        Acad Emerg Med. 2000; 7: 236-242
        • Tanabe P.
        • Gimbel R.
        • Yarnold P.R.
        • Kyriacou D.N.
        • Adams J.G.
        Reliability and validity of scores on The Emergency Severity Index version 3.
        Acad Emerg Med. 2004; 11: 59-65
        • Eitel D.R.
        • Travers D.A.
        • Rosenau A.M.
        • Gilboy N.
        • Wuerz R.C.
        The emergency severity index triage algorithm version 2 is reliable and valid.
        Acad Emerg Med. 2003; 10: 1070-1080
        • Chi C.H.
        • Huang C.M.
        Comparison of the Emergency Severity Index (ESI) and the Taiwan Triage System in predicting resource utilization.
        J Formos Med Assoc. 2006; 105: 617-625
        • van der Wulp I.
        • Schrijvers A.J.
        • van Stel H.F.
        Predicting admission and mortality with the Emergency Severity Index and the Manchester Triage System: a retrospective observational study.
        Emerg Med J. 2009; 26: 506-509
        • McHugh M.
        • Tanabe P.
        • McClelland M.
        • Khare R.K.
        More patients are triaged using the Emergency Severity Index than any other triage acuity system in the United States.
        Acad Emerg Med. 2012; 19: 106-109
        • Baumann M.R.
        • Strout T.D.
        Evaluation of the Emergency Severity Index (version 3) triage algorithm in pediatric patients.
        Acad Emerg Med. 2005; 12: 219-224
        • Durani Y.
        • Brecher D.
        • Walmsley D.
        • Attia M.W.
        • Loiselle J.M.
        The Emergency Severity Index Version 4: reliability in pediatric patients.
        Pediatr Emerg Care. 2009; 25: 751-753
        • Travers D.A.
        • Waller A.E.
        • Katznelson J.
        • Agans R.
        Reliability and validity of the emergency severity index for pediatric triage.
        Acad Emerg Med. 2009; 16: 843-849
        • Baumann M.R.
        • Strout T.D.
        Triage of geriatric patients in the emergency department: validity and survival with the Emergency Severity Index.
        Ann Emerg Med. 2007; 49: 234-240
        • Rivera D.R.
        • Gallicchio L.
        • Brown J.
        • Liu B.
        • Kyriacou D.N.
        • Shelburne N.
        Trends in adult cancer-related emergency department utilization: an analysis of data from the Nationwide Emergency Department Sample.
        JAMA Oncol. 2017; 3: e172450
        • Brown J.
        • Grudzen C.
        • Kyriacou D.N.
        • et al.
        the emergency care of patients with cancer: setting the research agenda.
        Ann Emerg Med. 2016; 68: 706-711
        • Caterino J.M.
        • Adler D.
        • Durham D.D.
        • et al.
        Analysis of diagnoses, symptoms, medications, and admissions among patients with cancer presenting to emergency departments.
        JAMA Netw Open. 2019; 2: e190979
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349
        • Richards C.T.
        • Gisondi M.A.
        • Chang C.H.
        • et al.
        Palliative care symptom assessment for patients with cancer in the emergency department: validation of the screen for palliative and end-of-life care needs in the emergency department instrument.
        J Palliat Med. 2011; 14: 757-764
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Rui P.
        • Kang K.
        National Hospital Ambulatory Medical Care Survey: 2015 emergency department summary tables.
        (Available at:)
        • American College of Emergency Physicians
        Triage scale standardization.
        (Available at:)
        • Green N.A.
        • Durani Y.
        • Brecher D.
        • DePiero A.
        • Loiselle J.
        • Attia M.
        Emergency Severity Index version 4: a valid and reliable tool in pediatric emergency department triage.
        Pediatr Emerg Care. 2012; 28: 753-757