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Abstract

Introduction: Following Hurricane Katrina and the 2009 H1N1 epidemic, pediatric critical care clinicians recognized the urgent need for a standardized pediatric triage system. The 2010 Pediatric Emergency Mass Critical Care (PEMCC) Taskforce could not recommend any current triage model but advised further research towards this goal. Hypothesis: Providers will prefer an objective pediatric triage system for PEMCC as compared to one that includes factors such as subjective evaluation, neuro-cognitive outcome or patient age. Methods: This cross-sectional survey used an audience response system with US healthcare providers who attended a regional pediatric disaster preparation symposium in 2012 to answer ethical and logistical questions about triage. Differences in opinions between respondents’ professions and hospital type were evaluated using a Student’s t-test. Results: 112 attendees responded (89% response rate); 55% were nurses, 26% physicians and 19% other providers. Work locations included pediatric hospitals (51%) vs. clinics, non-pediatric hospitals or other areas (49%). 59% of respondents agreed that a pediatric triage system should include both objective and subjective components. 59% prioritized children predicted to have a good neuro-cognitive outcome. 70% agreed that no pediatric age group should be prioritized. When considering the effect of workplace, 63% of non-neutral responding pediatric hospital providers preferred a pediatric triage system combining both a subjective evaluation by a care provider and an objective score compared with 37% from care settings other than a non-pediatric care settings (p= 0.04). Conclusions: In this regional survey of providers, the majority of respondents agree that a pediatric triage system should: 1) include both an objective score and a subjective evaluation, 2) prioritize predicted neuro-cognitive outcome but 3) should not include patient age. However, the majority of responders from settings other than pediatric hospitals prefer a triage system that excludes subjective evaluation. Further evaluation of community and provider opinion in other regions is clearly necessary to further the development of a nationally standardized pediatric triage system.