Artificial Intelligence in emergency department triage: A scoping review

Abstract

Background Triage in emergency departments (ED) is a critical process for prioritizing care and ensuring clinical safety. However, current triage systems often exhibit vulnerabilities that compromise the efficiency and quality of healthcare delivery. Artificial Intelligence (AI) has emerged as a promising innovation to support decision-making and optimize patient flow in these high-pressure environments. Objective To map the available evidence regarding the implementation and performance of artificial intelligence in emergency department triage. Method This scoping review followed the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guidelines. A comprehensive search was conducted across 13 databases (CINAHL, Cochrane Library, PubMed Central, SciELO, Web of Science, SCOPUS, Science Direct, VHL, Embase, and several regional dissertation repositories), with no language or time restrictions. Two independent reviewers performed the selection process using the Rayyan platform, with discrepancies resolved by a third evaluator. Data were synthesized using the PAGER framework, categorizing findings into Patterns, Advances, Gaps, Evidence for practice, and Recommendations for research. Results Nineteen studies met the inclusion criteria. AI was primarily implemented through Machine Learning (ML) algorithms, including Deep Learning architectures. Natural Language Processing (NLP) was frequently employed to process unstructured clinical data, with recent studies exploring the potential of Large Language Models (LLMs). Overall, ML-based models consistently outperformed traditional triage systems in predictive accuracy. These techniques were mainly utilized for automated classification, predicting clinical severity, and enhancing patient prioritization by integrating both objective and subjective assessment data. Conclusions The findings indicate that AI has significant potential to enhance emergency triage by streamlining service flows and providing robust clinical decision support. However, the current evidence remains heterogeneous and largely exploratory. Key challenges include variability in model performance, a lack of external validation, and studies often limited to specific populations. Consequently, many current tools still lack the necessary reliability for safe, large-scale clinical implementation.