EMERGENCY DEPARTMENT TRIAGE ACUITY AMONG INFLUENZA-RELATED VISITS IN THE UNITED STATES
Author(s)
ANITA MOHANDAS, MSc, MSPH1, Jordan Chase, BA2, Casey Tak, PHD3.
1DIRECTOR OF HEALTH ECONOMICS AND OUTCOMES RESEARCH, Cepheid, Sunnyvale, CA, USA, 2Value and Access, Cepheid, Sunnyvale, CA, USA, 3University of Utah, Salt Lake City, UT, USA.
1DIRECTOR OF HEALTH ECONOMICS AND OUTCOMES RESEARCH, Cepheid, Sunnyvale, CA, USA, 2Value and Access, Cepheid, Sunnyvale, CA, USA, 3University of Utah, Salt Lake City, UT, USA.
OBJECTIVES: To characterize Emergency Severity Index (ESI) triage distributions among influenza-related emergency department (ED) visits in the United States.
METHODS: We conducted a cross-sectional analysis of nationally representative ED visits from the National Hospital Ambulatory Medical Care Survey. Influenza-related visits were identified using influenza-like illness (ILI) symptoms or influenza diagnosis codes. Analyses were limited to visits with reported ESI triage status. ESI categories represent patient acuity and anticipated resource utilization: ESI 1 (immediate, life-threatening requiring resuscitation), ESI 2 (high-risk/emergent), ESI 3 (moderate acuity requiring multiple resources), ESI 4 (low acuity requiring one resource), and ESI 5 (minimal acuity requiring no resources). The proportion of visits was summarized across ESI categories (1-5). Survey weights were applied for nationally representative estimates. Data were analyzed in R Studio (v2026.05.0, Posit Software, Boston, MA).
RESULTS: Among ED visits with reported ESI status, influenza-related encounters were predominantly classified within mid- to low-acuity categories. Among ED visits with reported ESI status for ILI or influenza (weighted N≈9.81 million), where 39.0% of visits were ESI 3 and 50.0% were ESI 4, with smaller proportions in ESI 2 (6.9%), ESI 5 (3.6%), and ESI 1(0.4%). In contrast, the distribution across all ED visits for any diagnosis was more weighted toward higher acuity, with 15% classified as ESI 2 and 1% as ESI 1, alongside 51% ESI 3, 30% ESI 4, and 3% ESI 5.
CONCLUSIONS: Influenza-related ED visits are concentrated in mid- to low-acuity ESI categories, particularly ESI 3 and 4. The influenza cohort exhibited a higher proportion of visits within ESI 3 and 4 categories compared with all ED visits (89% vs. 80%). Despite lower clinical severity, these visits often require multiple resources and are subject to triage prioritization and care delivery processes, which may contribute to longer ED length of stay.
METHODS: We conducted a cross-sectional analysis of nationally representative ED visits from the National Hospital Ambulatory Medical Care Survey. Influenza-related visits were identified using influenza-like illness (ILI) symptoms or influenza diagnosis codes. Analyses were limited to visits with reported ESI triage status. ESI categories represent patient acuity and anticipated resource utilization: ESI 1 (immediate, life-threatening requiring resuscitation), ESI 2 (high-risk/emergent), ESI 3 (moderate acuity requiring multiple resources), ESI 4 (low acuity requiring one resource), and ESI 5 (minimal acuity requiring no resources). The proportion of visits was summarized across ESI categories (1-5). Survey weights were applied for nationally representative estimates. Data were analyzed in R Studio (v2026.05.0, Posit Software, Boston, MA).
RESULTS: Among ED visits with reported ESI status, influenza-related encounters were predominantly classified within mid- to low-acuity categories. Among ED visits with reported ESI status for ILI or influenza (weighted N≈9.81 million), where 39.0% of visits were ESI 3 and 50.0% were ESI 4, with smaller proportions in ESI 2 (6.9%), ESI 5 (3.6%), and ESI 1(0.4%). In contrast, the distribution across all ED visits for any diagnosis was more weighted toward higher acuity, with 15% classified as ESI 2 and 1% as ESI 1, alongside 51% ESI 3, 30% ESI 4, and 3% ESI 5.
CONCLUSIONS: Influenza-related ED visits are concentrated in mid- to low-acuity ESI categories, particularly ESI 3 and 4. The influenza cohort exhibited a higher proportion of visits within ESI 3 and 4 categories compared with all ED visits (89% vs. 80%). Despite lower clinical severity, these visits often require multiple resources and are subject to triage prioritization and care delivery processes, which may contribute to longer ED length of stay.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD95
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)