A study of triage of paediatric patients in Australia

Abstract

Objectives: To describe the triage of children in a sample of mixed and paediatric emergency departments in Australia in 1999 and to measure the inter‐rater reliability of the National Triage Scale when used by triage nurses for the triage of paediatric patients. Methods: A questionnaire was sent to 11 hospitals, including one paediatric and one mixed emergency department, in each state studied. Triage nurses were asked to assess 25 paediatric patient profiles and to assign appropriate triage categories to each profile. The number of responses within the modal triage category (concurrence), the percentage of responses with a concurrence of at least 50% and the number of responses within one triage category of the modal response (spread) of responses were measured. Triage data for 1999 from the same emergency departments were collected and numbers of children seen and admitted in each triage category were described. The patterns of distribution of triage categories for specific paediatric diagnoses (triage ‘footprints’) were also described. Data from mixed emergency departments were grouped and compared with data from paediatric emergency departments and any differences were described. Results: Seventy‐eight nurses in 10 hospitals responded to the questionnaire. Sixty‐three per cent of all responses had a concurrence of greater than 50%. Ninety‐four per cent of patient profiles were triaged to within one triage category of their modal response. Nurses in paediatric emergency departments (concurrence greater than 50% for 79% of responses) were significantly more consistent in their use of the National Triage Scale compared with nurses in mixed emergency departments (concurrence greater than 50% for 50% of responses). Paediatric emergency department triage nurses were more likely to use the full range of the National Triage Scale and were fourfold as likely to allocate triage categories 4 and 5 to patient profiles. Paediatric hospitals allocated patients to triage categories 4 and 5 for an average of 71% of presentations compared with 47% for mixed emergency departments. Specific diagnoses had characteristic distributions of triage categories, with similar differences seen when comparisons were made between mixed and paediatric emergency departments. Conclusion: Use of the National Triage Scale for the triage of paediatric patients by triage staff is not consistent and there are significant differences between the triage practices of paediatric and mixed emergency departments.

The accuracy and consistency of rural, remote and outpost triage nurse decision making in one Western Australia Country Health Service Region

“…Historically, specialty populations such as paediatrics have a lower level of consistency in triage decisions, 17 with paediatrics usually triaged more consistently by nurses within paediatric specialist EDs. 18 In contrast to previous reports, a comparison of adult and paediatric scenarios in this study found that there was no statistically significant difference in triage decision mean accuracy and consistency (p = 0.45). One explanation for this may be the introduction of the paediatric specific chapters in the ETEK, introduced in 2007.…”

The use of the soterion rapid triage system in children presenting to the Emergency Department

“…Durojaiye and O'Meara reported on their experience using the Australasian National Triage Scale (NTS) in pediatric patients (18). The authors found an alarmingly high 35% admission rate among patients triaged as low acuity in pediatric EDs.…”

Reliability of triage systems for paediatric emergency care: a systematic review

“…The search strategy led to the selection of 20 articles on nine triage systems for paediatric emergency care: the National Triage System (n=1),18 which was the precursor of the ATS (n=3)19–21; the paediatric version of the CTAS PedCTAS (n=5)22–26; the ESI from the USA (n=5)27–31; the MTS from the UK (n=1)32; Princess Marina Triage Scale (n=1),33 which is an adaptation of the South African Triage Scale for Botswana; the Soterion Rapid Triage System - SRTS from the USA (n=1)34; the paediatric version of the Rapid Emergency Triage and Treatment System (RETTS-p) from Sweden (n=2)35 36 and the Paediatric Risk Classification Protocol from Brazil (n=1)37 (online supplementary file A, figure 1 and table 1). …”