High Risk Criteria in Level 2 May Provide a Source of Disagreement in Emergency Severity Index

With great interest we have read the outstanding publication in the recent Bulletin of Emergency and Trauma issue by Ghafarypour-Jahrom et al. entitled “Validity and Reliability of the Emergency Severity Index and Australasian Triage System in Pediatric Emergency Care of Mofid Children’s Hospital in Iran” [1]. We bring your attention to the results concerning the reliability of Emergency Severity Index (ESI) in the mentioned study that may provide a new understanding to lead clinical practice in emergency department (ED). The study used Cohen kappa values to report inter-rater reliability of Level 1 to 5 are 0.833, 0.777, 0.520, 0.850 and 0.883. The reliability coefficient for level 4, 5 and 1 is almost perfect (> 0.80) which is reported in other literature too [2]. The reliability coefficient for level 2 and 3 is substantial and moderate respectively, implying that the agreement between raters suffers from discrepancy. This issue is even more remarkable while bearing in mind that a large number of patients in the ED belong to these categories. Besides, these patients have strong potential to get into critically ill condition. Therefore, it is vital to address this flaw in the literature