Pediatric emergency triage systems

Abstract

Objective: The aim of this study was to perform a narrative review of the leading pediatric triage systems in emergency departments (EDs). Data source: Articles published between 1999 and 2019 were identified by searching the MEDLINE, EMBASE, and PubMed databases using the keywords “pediatric triage”, “pediatric assessment tools”, and “emergency department triage” with an emphasis on studies that evaluated the validation and reliability of triage systems. Data synthesis: A total of 105 articles on pediatric emergency triage systems in 12 countries were evaluated. Triage systems were divided into two groups: color-stratified triage systems and alert systems. The color-stratified triage systems included in this review were the Canadian Triage and Acuity Scale (CTAS), Manchester Triage System (MTS), Emergency Severity Index (ESI), and Australasian Triage Scale (ATS), and the alert systems included were the Paediatric Observation Priority Score (POPS), Pediatric Early Warning Score (PEWS), and Pediatric Approach Triangle (PAT). Evidence corroborates the validity and reliability of MTS, PaedCTAS, ESI version 4, PEWS, POPS, and PAT in pediatric emergency services. Conclusions: These are fundamental tools for risk classification of patients seeking treatment in EDs. Not all triage systems have been assessed for validity and reliability; nor are they well suited for all regions of the world. Employing triage systems in Brazil requires cultural adaptation and rigorous training of the local health staff, in addition to validation and reliability studies in our country, since the social and cultural context of this country differs from those where these tools were developed.

Red Code Management in a Pediatric Emergency Department: A Retrospective Study

“…RCs require prompt recognition to ensure their adequate management and to improve their outcome [1][2][3]. According to the international literature, an efficient triage system is needed to a correct priority code assignment: alongside vital signs, nurses' experiences are crucial to catching PAT alterations, which, in our study, were the main motives of the RC definition [1,3,19].…”

“…RCs require prompt recognition to ensure their adequate management and to improve their outcome [1][2][3]. According to the international literature, an efficient triage system is needed to a correct priority code assignment: alongside vital signs, nurses' experiences are crucial to catching PAT alterations, which, in our study, were the main motives of the RC definition [1,3,19]. The assessment of vital signs plays a crucial role non only in triage code assignment but also in the management according to the PALS protocols, with the goal of the fast recognition of respiratory distress, respiratory failure, and shock to immediately take life-saving interventions [3,9,20].…”

“…In the emergency department (ED), an adequate triage system is needed to ensure that children with severe conditions can be immediately identified and quickly directed toward appropriate care [1][2][3]. The red code (RC) represents the highest urgency and requires immediate medical assessment [4].…”

“…The triage code assignment derives from different evaluations. The first component is the "quick look", a rapid assessment that does not require equipment but only visual and auditory evaluation to assess the appearance of the patient, respiratory function, and skin circulation, reflecting the brain function, oxygenation, ventilation, and perfusion of the child [1,[8][9][10], followed by the evaluation of the main complaint and the vital signs, including pain. The RC is defined as the absence or compromission of one or more vital functions and represents the priority access to medical evaluation; it constitutes a minority among pediatric ED admissions, representing 0.25-1% of total admissions according to local statistics [4,8].…”

A Review of the Roles and Implementation of Pediatric Emergency Triage Systems in China and Other Countries

“…Studies on pediatric triage systems have also been conducted in many other countries, such as China, South Africa, and Thailand to create a pediatric triage system in line with the situation of their respective countries. The variety of triage tools used in different countries makes it difficult to compare them, but there is an increasing number of studies on pediatric emergency triage in many countries around the world [ 5 ]. We aimed to review the roles and implementation of pediatric emergency triage systems in China and other countries.…”