{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T12:50:39Z","timestamp":1782737439226,"version":"3.54.5"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:p>\n            Objective\u2003The Emergency Severity Index (ESI) version 4 is a 5-level triage system (1 being the highest acuity and 5 being the lowest acuity) used in the emergency department (ED). Our goal of the study was to compare rates of readmission according to ESI in postpartum women.<\/jats:p><jats:p>\n            Study Design\u2003This was a secondary analysis of a retrospective cohort study of all women who presented to the ED within 6 weeks after cesarean delivery. The acuity level was assigned by triage nurses at the time of triage presentation. Our primary outcome was postpartum readmission. To examine if the addition of blood pressure to vital sign abnormalities would improve the prediction for readmission, we created a modified ESI. We identified women who had an ESI of level 3 and reassigned to a modified ESI of level 2 if blood pressure was in the severe range. Receiver operating characteristic curves with area under the curve (AUC) were created and compared between ESI and modified ESI.<\/jats:p><jats:p>\n            Results\u2003Of 439 women, ESI distribution was 0.2% ESI 1, 23.7% ESI 2, 56.0% ESI 3, 19.4% ESI 4, and 0.7% ESI 5. Readmission rates by ESI level were 100% ESI 1, 47% ESI 2, 18% ESI 3, 2% ESI 4, and 0% ESI 5 (p\u2009&lt;\u20090.001). Of 246 women who were assigned an ESI of 3, total 25 had severe range blood pressures and were reassigned to a modified ESI of 2. Of these 25 women, 14 were readmitted. The AUC of the modified ESI was statistically higher than that of the standard ESI (AUC: 0.77 and 95% confidence interval: 0.72\u20130.82 vs. AUC: 0.73 and 95% confidence interval: 0.68\u20130.78; p\u2009&lt;\u20090.01).<\/jats:p><jats:p>\n            Conclusion\u2003The ESI was a useful tool to identify women who required postpartum readmission. Incorporation of severe range blood pressure as a parameter of acuity improved the prediction of readmission.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0040-1715847","type":"journal-article","created":{"date-parts":[[2020,8,30]],"date-time":"2020-08-30T22:31:21Z","timestamp":1598826681000},"page":"312-318","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of the Emergency Severity Index (Version 4) in Postpartum Women after Cesarean Delivery"],"prefix":"10.1055","volume":"39","author":[{"given":"Tetsuya","family":"Kawakita","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia"},{"name":"Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Thomas","sequence":"additional","affiliation":[{"name":"Georgetown University, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helain J.","family":"Landy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,8,30]]},"reference":[{"key":"ref1","volume-title":"Emergency Severity Index (ESI). A triage tool for emergency departments"},{"key":"ref2","volume-title":"Emergency Severity Index (ESI). A triage tool for emergency departments"},{"issue":"08","key":"ref3","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1097\/PEC.0b013e3182621813","article-title":"Emergency severity index version 4: a valid and reliable tool in pediatric emergency department triage","volume":"28","author":"N A Green","year":"2012","journal-title":"Pediatr Emerg Care"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/j.1553-2712.2004.tb01371.x","article-title":"Reliability and validity of scores on The Emergency Severity Index version 3","volume":"11","author":"P Tanabe","year":"2004","journal-title":"Acad Emerg Med"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.jemermed.2019.05.023","article-title":"Validation of the emergency severity index (Version 4) for the triage of adult emergency department patients with active cancer","volume":"57","author":"D Adler","year":"2019","journal-title":"J Emerg Med"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"38.e1","DOI":"10.1016\/j.ajog.2010.02.033","article-title":"Emergency department use during the postpartum period: implications for current management of the puerperium","volume":"203","author":"S L Clark","year":"2010","journal-title":"Am J Obstet Gynecol"},{"issue":"09","key":"ref7","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1089\/jwh.2014.5125","article-title":"Emergency room utilization after medically complicated pregnancies: a Medicaid claims analysis","volume":"24","author":"A Harris","year":"2015","journal-title":"J Womens Health (Larchmt)"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1097\/AOG.0000000000002269","article-title":"Emergency department care in the postpartum period: California Births, 2009-2011","volume":"130","author":"P Batra","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"113.e1","DOI":"10.1016\/j.ajog.2016.01.174","article-title":"A multi-state analysis of postpartum readmissions in the United States","volume":"215","author":"M A Clapp","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/AOG.0000000000003091","article-title":"Reducing cesarean delivery surgical site infections: a resident-driven quality initiative","volume":"133","author":"T Kawakita","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref11","first-page":"e1","article-title":"ACOG practice bulletin no. 202: gestational hypertension and preeclampsia","volume":"133","author":"The American College of Obstetricians and Gynecologists","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1177\/1536867X0200200307","article-title":"From the help desk: comparing areas under receiver operating characteristic curves from two or more probit or logit models","volume":"2","author":"M A Cleves","year":"2002","journal-title":"The Stata Journal"},{"key":"ref13","volume-title":"Chapter 5. The role of vital signs in ESI triage. Content last reviewed October 2014"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.ajog.2011.09.002","article-title":"Etiology and management of postpartum hypertension-preeclampsia","volume":"206","author":"B M Sibai","year":"2012","journal-title":"Am J Obstet Gynecol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1715847.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T00:11:46Z","timestamp":1644538306000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1715847"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,30]]},"references-count":14,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2022,2,10]]},"published-print":{"date-parts":[[2022,2]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1715847","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,30]]}}}