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Nurse Scientist Taps Arcus Data to Assess Pediatric Emergency Triage Accuracy

Published on May 28, 2024 in Cornerstone Blog · Last updated 1 month 3 weeks ago


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Warren Frankenberger, PhD, RN

Warren Frankenberger, PhD, RN

By schweigl [at] (Lorene Schweig)

Editor's Note: This article originally appeared in the December 2023 edition of "The Pulse," an internal eNewsletter published by the Department of Nursing and Clinical Care Services at Children's Hospital of Philadelphia.

A Children's Hospital of Philadelphia nurse scientist is leveraging the power of data to improve the safety and effectiveness of emergency department triage for children.

Warren Frankenberger, PhD, RN, received a $100,000 research award from the National Institute of Child Health and Human Development (NICHD) to conduct research in pediatric emergency care. The goal is to determine the accuracy of a triage tool—the Emergency Severity Index (ESI)—used to assess and prioritize the level of urgent care that a child receives in the emergency department.

ESI was developed to help healthcare providers quickly evaluate the severity of a patient's condition. Although designed for adults, the tool has been widely adopted for use in children. However, since its adoption in 2012, several small studies have shown that ESI did not accurately reflect some children's health risks.

"The potential for missed diagnoses and delayed treatment due to inaccurate triage is significant considering that the number of pediatric visits to U.S. emergency departments is about 30 million per year," said Dr. Frankenberger, who is also an adjunct assistant professor at the University of Pennsylvania School of Nursing. "Evidence from a large, multicenter clinical study is needed to fully understand ESI's safety and effectiveness when used in infants, children, and adolescents."

Dr. Frankenberger will be performing a retrospective review using the database of the Pediatric Emergency Care Applied Research Network. The database contains data for more than five million pediatric emergency department visits from 12 hospitals across the United States that used ESI for 10 or more years to triage a diverse group of patients aged 17 years and younger.

Additional members of Dr. Frankenberger's research team include Co-investigator Joseph Zorc, MD, MSCE, Mark Fishman Endowed Chair in Genomics and Computational Science at CHOP and professor of Pediatrics at the University of Pennsylvania, and Mentor-Consultant Martha Curley, PHD, RN, FAAN, Ruth M. Colket Endowed Chair in Pediatric Nursing at CHOP and professor of Nursing, Anesthesiology, and Critical Care Medicine at Penn. In addition to evaluating ESI's accuracy in correctly identifying pediatric health risks, the team will be analyzing individual factors, such as age, race, ethnicity, and complex healthcare needs, that could affect ESI's accuracy.

This study builds on Dr. Frankenberger's previous research through a major collaboration between the CHOP Center for Pediatric Nursing Research and the CHOP Research Institute Arcus team. Dr. Frankenberger's Arcus-based research, one of many studies in the collaboration, assessed ESI's accuracy in more than 300,000 emergency department visits at CHOP using natural language processing technology. Their findings appear in the Journal of Emergency Nursing.

"The findings from Dr. Frankenberg's latest study were integral to this NICHD grant award and demonstrate the importance of interprofessional research collaborations," said Margaret McCabe, PhD, RN, FAAN, senior director, Center for Pediatric Nursing Research and Evidence-Based Practice. "This is just one example of how nurse-led research at CHOP is successfully addressing national challenges in pediatric healthcare that may ultimately lead to improved care delivery and outcomes for children and families."

Dr. Frankenberger's research is supported by the National Institute of Child Health and Human Development of the National Institutes of Health.