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Diagnostic test accuracy of the Emergency Severity Index: a systematic review and meta-analysis
Authors: Bettina Wandl, Jan D. Kellerer, Verena Fuhrmann, Karina Tapinova, Dominik Roth, Gerhard Müller
Source: https://doi.org/10.1097/MEJ.0000000000001262
Methods
We searched four bibliographic databases up to 13 February 2025. Screening, inclusion, data extraction, and assessment of methodological quality followed standard Cochrane methodology. We calculated measures of DTA for all studies against the reference standards and calculated pooled estimates using a bivariate random effects model.
Main results
We included 27 studies, representing 510 777 patients. Methodological quality according to the QUADAS-2 tool was high, except for risk of bias in patient selection, which was high for 12 (44%) studies. A total of 18 studies provided data for the reference standard shortterm mortality, with an estimated pooled sensitivity of 81.8 [95% confidence interval (CI): 71.8–88.9], specificity of 70.5 (60.5–78.8), diagnostic odds ratio (DOR) of 10.8 (5.4–21.4), positive likelihood ratio of 2.77 (2.02–3.81), and negative likelihood ratio of 0.26 (0.16–0.41). For the reference standard ICU admission, based on 10 studies, pooled estimates were sensitivity of 81.5 (65.2–91.2), specificity of 81.7 (71.9–88.6), DOR of 19.7 (5.5–70.7), positive likelihood ratio of 4.45 (2.58–7.84), and negative likelihood ratio of 0.23 (0.11–0.49). Those results remained stable in the sensitivity analysis.
Conclusion
ESI showed a moderate-to-high diagnostic accuracy for identifying critically ill patients at the ED. These findings support the role of the ESI guided by a principal understanding of the limitations inherent to any triage tool.
A qualitative study on public health competencies of community health nurses in Austria
Authors: Stephanie Kainrath, Harald Lidauer, Gerhard Müller, Harald Stummer
Source: https://doi.org/10.1007/s10389-025-02600-3
Aim
The World Health Organization identifies primary care as foundational to both health systems and broader community development. In Austria, general practitioners dominate first-level care, unlike countries such as Norway, Finland, and Ireland, which integrate nurses into primary care. In response in 2020, the Austrian government planned to introduce a community health nursing model. This article focuses on the public health competencies required for community health nurses.
Subject and methods
The study aims to identify key public health competencies for community health nurses, providing insights to inform their training and education. Fifteen experts in community health nursing and public health were interviewed in a qualitative study. Transcripts were analyzed using qualitative content analysis, adhering to recognized research standards.
Results
Public health competencies are vital for community health nurses working across Austria’s health and social care systems. Key areas include: (a) institutions, structures, and health policy, (b) data competency — collecting, interpreting, and applying data, particularly in epidemiology and research, (c) population engagement — working effectively with diverse and vulnerable populations, informed by social epidemiology.
Conclusion
Public health competencies are essential to the role of community health nurses in Austria. Training should emphasize epidemiology, health systems knowledge, and disaster preparedness to support their contribution to health equity, system resilience, and improved population outcomes.