associated factors of under and over-triage based on the emergency severity index; a retrospective cross-sectional study

Introduction: under-triage increases patients’ risks for morbidity and mortality, whereas over-triage limits the resources available to sicker patients. this study aimed to determine the rates as well as associated factors of under-triage and over-triage in emergency department (ed), based on emergency severity index (esi) triage system. methods: in this retrospective cross-sectional study, triage level of ed patients based on the esi version 4, was studied during a 9-month period in 2019. patients’ esi level, which were examined by triage nurses were reevaluated by 3 emergency physicians and the rate of correct, under-, and over-triage as well as their associated factors were analyzed. results: 1000 cases of triage were evaluated. triage was correct in 69.1% of cases. the rate of under-triage was 4.9%, and that of over-triage was 26.0%. over-triage was significantly more common among patients aged 18–30 years than for those aged ≥65 years (adjusted odds ratio [or] = 1.73; 95% confidence interval [ci]: 1.07–2.81; p = 0.026); those with traumatic injuries (adjusted or = 1.80; 95% ci: 1.29–2.52; p = 0.001); those arriving at the hospital during the evening shift (adjusted or = 1.42; 95% ci: 1.01–2.0; p = 0.046); patients who were hospitalized (adjusted or = 0.35; 95% ci: 0.22–0.54; p < 0.001); and those with severe pain (adjusted or = 0.28; 95% ci: 0.10–0.84; p = 0.023). younger age was also significantly associated with under-triage. patients aged 18–30 years were under-triaged more often than those aged ≥65 years (adjusted or = 3.05; 95% ci: 1.16–8.00; p = 0.023). conclusions: over-triage was substantially more common than under-triage in vajira hospital. factors associated with over-triage were younger age, traumatic injury, arrival time, hospital admission, and severe pain. younger age was the only factor related to under-triage.