High rate of missing vital signs data at triage in a paediatric emergency department

Abstract

Vital signs measurement is considered standard practice in paediatric emergency department triage assessment, but studies have shown variable incidence of missing data. To evaluate the rate of missing data for vital signs at triage and to determine clinical and environmental predictive factors. A retrospective cohort design was used to study a database of consecutive patients registered at a tertiary paediatric emergency department during randomly chosen shifts. Demographic and clinical data were collected. Univariate and multivariate logistic regression analyses were performed to evaluate the determinants of missing data for body temperature, heart rate, respiratory rate, blood pressure and pulse oximetry. There were 2081 patients triaged during the study periods. On multivariate logistic regression analysis, triage level (from 1 = priority to 4 = nonurgent) was an independent predictor of missing data for heart rate, respiratory rate, blood pressure and pulse oximetry (OR 1.48 to 2.05). Patients visiting the emergency department during the day shift (OR 1.08 to 4.72) and the evening shift (OR 1.38 to 9.24) had a higher rate of missing data than those visiting during the night shift. A decreased level of consciousness, an immunocompromised state and referral by a physician did not meet statistical significance as predictive factors. There was a high rate of missing data for vital signs. Factors related to patients' clinical characteristics, such as acuity of triage level, were associated with a higher rate of vital signs documentation at triage. An environmental factor, shift of presentation, was also independently associated with a higher rate.