Validation of Songklanagarind Pediatric Triage Model in the Emergency Department; a Cross-Sectional Study
学术急诊医学档案,
卷 9 编号 1 (2021),
1 一月 2021
,
第 e39 页
https://doi.org/10.22037/aaem.v9i1.1237
摘要
Introduction: An effective triage needs to consider many factors, such as good triage protocol, experienced triage nurses, and patient factors. This study aimed to evaluate the validity of Songklanagarind Pediatric Triage (SPT) for triage of pediatric patients in the emergency department (ED) and identify the factors associated with triage appropriateness.
Methods: This study was done in two phases. In the first phase, a team of emergency physicians, a pediatric emergency physician, and a pediatric critical care physician developed SPT model by considering and combining Emergency Severity Index (ESI), Pediatric Assessment Triangle (PAT), Pediatric Canadian Triage and Acuity Scale (PaedCTAS), and Pediatric Septic Shock early warning signs protocol of the hospital as the core concept. In the second phase, a prospective observational study was conducted in the ED of Songklanagarind Hospital, which is a tertiary university hospital in southern Thailand, from September to October 2019 to evaluate the accuracy of the developed triage model.
Results: A total of 520 pediatric patients met the inclusion criteria. The pediatric triage model had sensitivity and specificity values of 98.28% and 26.24%, respectively, and positive and negative predictive values of 27.67% and 98.15%, respectively, in prediction of death, hospitalization, and resource utilization. The rates of appropriate triage, over-triage, and under-triage were 68.8%, 28.5%, and 2.7%, respectively. Significant factors associated with appropriateness of triage were underlying disease of the respiratory system (OR = 4.16, 95%CI: 1.75‒9.23), fever (OR = 0.60, 95%CI: 0.41‒0.88), dyspnea (OR: 6.38, 95%CI: 2.51‒16.22), diarrhea (OR = 0.26, 95%CI: 0.09‒0.73), oxygen saturation <95% (OR = 3.18, 95%CI: 1.09‒9.27), accessory muscle use during breathing (OR = 3.67, 95%CI: 1.09‒12.41), and wheezing or rhonchi (OR = 6.96, 95%CI: 3.14‒15.43).
Conclusion: SPT showed good correlation of hospital admission rates and resource utilization with pediatric triage level of urgency. However, further efforts are needed to decrease the rates of over- and under-triage.
- Triage
- pediatrics
- reproducibility of results
- emergency service
- hospital
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参考
Physicians ACoE. Crowding 2019 [Available from: https://www.acep.org/patient-care/policy-statements/crowding/.
McNally S. Let's have standards for triage education and practice. Australian Emergency Nursing Journal. 2001;4(2):12-4.
Patel VL, Gutnik LA, Karlin DR, Pusic M. Calibrating urgency: triage decision-making in a pediatric emergency department. Advances in health sciences education. 2008;13(4):503-20.
Baumann MR, Strout TD. Evaluation of the Emergency Severity Index (version 3) triage algorithm in pediatric patients. Academic Emergency Medicine. 2005;12(3):219-24.
Mor M, Waisman Y. Triage principles in multiple casualty situations involving children: the Israeli experience. Pediatric Emergency Medicine Database (serial online). 2002.
de Magalhães-Barbosa MC, Robaina JR, Prata-Barbosa A, de Souza Lopes C. Validity of triage systems for paediatric emergency care: a systematic review. Emergency Medicine Journal. 2017;34(11):711-9.
Hinson JS, Martinez DA, Schmitz PS, Toerper M, Radu D, Scheulen J, et al. Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. International journal of emergency medicine. 2018;11(1):1-10.
Wuthisuthimethawee P, Boonchai P. Validity and Reliability of the Modified Emergency Severity Index (ESI) Version 4 for Pediatric Triage in the Emergency Department, Songklanagarind Hospital, Thailand. JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND. 2019;102(4):449-54.
Dieckmann RA, Brownstein D, Gausche-Hill M. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatric emergency care. 2010;26(4):312-5.
Warren DW, Jarvis A, LeBlanc L, Gravel J, Group CNW. Revisions to the Canadian triage and acuity scale paediatric guidelines (PaedCTAS). Canadian Journal of Emergency Medicine. 2008;10(3):224-32.
Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernández‐Frankelton M, et al. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Academic Emergency Medicine. 2004;11(1):38-50.
Cooper RJ, Schriger DL, Flaherty HL, Lin EJ, Hubbell KA. Effect of vital signs on triage decisions. Annals of emergency medicine. 2002;39(3):223-32.
di Martino P, Leoli F, Cinotti F, Virga A, Gatta L, Kleefield S, et al. Improving vital sign documentation at triage: an emergency department quality improvement project. Journal of patient safety. 2011;7(1):26-9.
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