Introduction: Peripheral perfusion index (PPI) and shock index (SI) are considered valuable predictors of hospital
outcome and mortality in various operative and intensive care settings. In the present study, we evaluated the
prognostic capabilities of these parameters for performing emergency department (ED) triage, as represented
by the emergency severity index (ESI).
Methods: This prospective cross-sectional study included 367 patients aged older than 18 years who visited the
ED of a tertiary referral hospital. The ESI triage levels with PPI, SI, and other basic vital sign parameters were recorded
for each patient. The hospital outcome of the patients at the end of the ED period, such as discharge, admission
to the hospital and death were recorded.
Results: A total of 367 patients (M/F: 178/189) admitted to the EDwere categorized according to ESI and included
in the study. A decrease in diastolic BP, SpO2 and PPI increased the likelihood of hospitalization and 30-day mortality.
Based on univariate analysis, a significant improvement in performance was found by using age, diastolic
BP, mean arterial pressure, SpO2, SI and PPI in terms of predicting high acuity level patients (ESI < 3). In the
multivariable analysis only SpO2 and PPI were found to predict ESI < 3 patients.
Conclusion: Peripheral perfusion index and SI as novel triage instruments might provide useful information for
predicting hospital admission and mortality in ED patients. The addition of these parameters to existing triage
instruments such as ESI could enhance the triage specificity in unselected patients admitted to ED.