Objective: To evaluate the effect of altering pediatric triage criteria on E D triage scoring and patient flow.Methods: A prospective observational study of a pediatric triage modification was performed. Data for all pediatric patients presenting to an urban general ED during a six-month study period were collected. After the first three months, pediatric triage criteria were altered by elevating the acuity of several historical items and specifically listing abnormal signs and symptoms. Outcome measures included triage score assignment, criteria making the patient emergent, proportion of emergent or urgent triage assignments, and times to examination, disposition, and admission.Results: Altering pediatric triage criteria resulted in a significant (p < 0.05) increase in the number of patients triaged as emergent (2% vs 15%) or urgent (48% vs 55%). In addition, for emergent and urgent patients there was a significant decrease (p < 0.05) in the mean times to ED examination (50 vs 44 min), floor admission (355 vs 245 min), and intensive care unit admission (221 vs 132 min). The triage changes that had a significant impact on these results were a history of color change, decreased activity, and prematurity with complications.Conclusions: A significant improvement in pediatric patient flow occurred after posting age-specific abnormal signs and symptoms as well as elevating triage acuity for specific historical clues. I Due to the large number of patients presenting to general EDs, triage must be used to select out critically ill patients.Numerous studies of triage have elucidated important principles in the application of triage criteria to emergency patients. These include practical, time-efficient use by medical personnel and sensitive criteria that capture all potentially critical patients (i.e., sensitivity is more important than specificity). In addition, successful triage requires an emphasis on patient complaints, patients at the extremes of age, patients with high-risk findings on a brief screening examination, and those with high-risk premorbid i l l n e~s e s .~-'~ Fi- nally, significant historical cues concerning the current illness and the clinical impression of the screening health professional must be considered. Specific problems pertinent to pediatric patient screening include: the inapplicability of adult triage criteria to pediatric disease presentation; the increased morbidity for similar diseases; the frequent unreliability of the clinical impression, even with experienced triage personnel; and the variability of symptoms during the course of i l l n e~s . '~ Although no triage criteria are perfect, modifications to adult criteria should be adopted that improve triage sensitivity.Preliminary studies in our large urban general E D suggested that adults were being seen sooner than were equally ill pediatric patients, resulting in unacceptable waiting times for seriously ill pediatric patients. The purpose of this study was to examine the impact of specific alterations to an existing pediatric triage...
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