Non-urgent Conditions Research Articles

Adherence to Well-Child Care and Home Visiting Enrollment Associated with Increased Emergency Department Utilization.

Pediatric primary care and home visiting programs seek to reduce health disparities and promote coordinated health care use. It is unclear whether these services impact high-cost, emergency department (ED) utilization. We evaluated the association of well-child care (WCC) and home visiting with ED visit frequency for children < 1year with an established medical home. Retrospective cohort study using linked administrative data for infants ≥ 34weeks' gestation from 2010 to 2014, within a multisite, academic primary care system. Latent class analysis characterized longitudinal patterns of WCC. Multivariable negative binomial regression models tested the independent association between WCC patterns and home visiting enrollment with ED visits. Among 10,363 infants, three WCC latent classes were identified: "Adherent" (83.4% of the cohort), "Intermediate" (9.7%), and "Decreasing adherence" (7.0%). Sixty-one percent of the sample had ≥ 1 ED visit in the first 12months of life, and 73% of all ED visits were triaged as non-urgent. There was a significant interaction effect between WCC pattern and insurance status. Among Medicaid-insured infants, "Intermediate" and "Decreasing adherence" WCC patterns were associated with a lower incident rate of ED visits compared with the "Adherent" pattern (incident rate ratios (IRR) 0.88, p = 0.03 and 0.79, p < 0.001 respectively); this effect was not observed among privately-insured infants. Home visiting enrollment was independently associated with a higher rate of ED visits (IRR 1.24, p < 0.001). Among infants with an established medical home, adherence to recommended WCC and home visiting enrollment was associated with greater ED use for non-urgent conditions.

One Stop: Examining the Reasons Patients Use the Emergency Department for Nonurgent Care and the Barriers They Face

IntroductionDespite the plethora of research on the use of emergency department services for nonurgent primary health care, the vast majority of this research is quantitative in nature. To date, there is little research that reports on the problem from the patients’ perspective and/or lived experience, which compromises health care providers’ understanding of the essence of the problem as described by the patients. Thus, this study will provide a qualitative description of nonurgent ED visits from the patients’ perspective. Specifically, this study answers the following research questions: 1) What are the reasons for patients and/or caregivers visiting the emergency department for nonurgent health conditions? and 2) What are the barriers experienced by patients and/or caregivers when seeking access to health care? MethodsA qualitative descriptive design with face-to-face interviews of 33 consenting participants was conducted at 4 emergency departments. All interviewed participants were triaged as nonurgent patients by the ED personnel. ResultsThree themes surfaced from the data regarding reasons for using the emergency department: 1) Practitioner referral; 2) Efficacy of care; and 3) Time saver. When describing barriers that participants experienced when seeking care outside of the emergency department for their nonurgent conditions, 3 themes that emerged are lack of primary care provider, financial difficulties, and lack of comprehensive care outside the emergency department. DiscussionThe results of the study can help inform patient-centered care and future policy initiatives that will address the practices and barriers contributing to nonurgent ED visits.

Emergency department visits for non-urgent conditions in Iran: a cross-sectional study

ObjectivesTo determine the percentage of non-urgent (NU) visits in an Iranian emergency department (ED), to explore why patients with NU conditions refer to EDs and also to assess the association...

383 High-Resolution Esophageal Manometry in the Inpatient Setting: Is There a Role?

INTRODUCTION: High-resolution esophageal manometry (HReM) is used by gastroenterologists to evaluate a variety of symptoms including dysphagia, heartburn, and non-cardiac chest pain (NCCP). Traditionally, evaluation of those non-urgent conditions is done on outpatient basis; however, depending on practice and availability, HReM may be performed in the inpatient setting. In this study, we aim to characterize the population undergoing inpatient versus outpatient HReM. In addition, we aim to identify whether those inpatient studies resulted in any immediate action during the hospitalization in a specific subgroup. METHODS: This was a single-center retrospective study. Patients eighteen-years or older who underwent either inpatient or outpatient HReM between March 1st, 2015 and September 1st, 2018 were included. Demographic and clinical information were obtained from medical records. RESULTS: A total of 263 patients were included in this study: 76 patients who underwent inpatient HReM and 177 who underwent outpatient HReM. Demographic characteristics were similar between groups. Patients who underwent inpatient HReM had lower mean BMI (26 (±7.5) vs. 28 (±6), P = 0.022) and were more likely to have diabetes (27.6% vs. 14.7%, P = 0.021), chronic obstructive lung disease (COPD) (10.5% vs. 3.4%, P = 0.034), heart failure (21% vs. 2.8%, P &lt; 0.001) and history of aspiration (25% vs. 6.8%, P &lt; 0.001) (Table 1). Symptoms reported by patients were similar among groups with exception of weight loss (52.5% vs. 22%, p &lt; 0.001, inpatient vs. outpatient respectively). Dysphagia, gastroesophageal reflux disease (GERD) and NCCP were the main indication for HReM. The inpatient group had more dysphagia (67% vs. 54.2%, P = 0.003) and less GERD as an indication (15.8% vs. 40.7%, p &lt; 0.001). From the 76 inpatients, 23 (30.3%) underwent further intervention while inpatient (Table 2). On multivariate analysis, need for alternative diet/nutrition prior to HReM had a strong association with inpatient intervention, with an odds ratio (ORs) of 5.99 (95% confidence interval (CI) 1.53-23.39; P = 0.01). CONCLUSION: There appear to be discrete differences between the inpatient and outpatient manometry groups. When performed in the inpatient setting HReM resulted in additional procedures in a small percentage of patients and need for alternative diet/nutrition was a predictor for further procedures. These findings indicate that inpatient manometry may be suitable in a selected group of patients.

How Important Are Parental Age and Educational Level in Nonurgent Admissions to the Pediatric Emergency Department?

The aims of the present study were to investigate the reasons parents prefer the pediatric emergency department for nonurgent admissions and to evaluate the effect of parental age and educational level on nonurgent admissions and the relationship between the reasons for nonurgent admissions and child age. We conducted a cross-sectional survey at an emergency department of a tertiary care pediatric referral center. A questionnaire that was prepared to understand the reasons underlying nonurgent admissions was administered to the parents of 1033 children who were classified as nonurgent cases using the Pediatric Canadian Triage and Acuity Scale (4-5). The most common reasons for nonurgent admissions were the concern for progression in child's complaints, the complaints with an onset outside working hours, and the parental perception that more cautious and better care is provided in the emergency department. The most urgent complaints from the parental perspective included fever (23.1%), vomiting (11.0%), and diarrhea (10.5%), respectively. The mean age of the mothers was 31.1 ± 5.9 years (17-51 years), and the mean age of the fathers was 34.94 ± 6.1 years (20-60 years). Parents younger than 30 years were more likely to prefer the emergency department due to convenience and economic reasons. Nonurgent admissions due to confidence in the emergency department were more frequent among parents who were primary school graduate. It is critically important to examine why parents prefer the emergency department for nonurgent conditions of their children and to develop solution offers in this regard. The improvements to be made in the emergency department would both prioritize patients requiring urgent care and increase the productivity of emergency department staff.

An examination of visits to the pediatric emergency departments for emergent, urgent and non-urgent ocular conditions

An examination of visits to the pediatric emergency departments for emergent, urgent and non-urgent ocular conditions

Exploring the characteristics, acuity and management of adult ED patients at night-time

ObjectivesED care is required for acutely unwell and injured patients 24 hours a day, 7 days a week. The aim of this study was to compare characteristics and activity of...

A Hybrid Data Mining Approach for Generalizing Characteristics of Emergency Department Visits Causing Overcrowding

Hospital emergency department (ED) crowding has led to an increase in patient waiting times; solving this problem requires a better understanding of the patient behavior. In this work, we adopt decision tree analysis which facilitate the interpretation and understanding of ED visits at Mackay Memorial Hospital, a representative ED in our country. Accordingly, a hybrid data mining approach is proposed to predict patients’ LOS and explain their associated characteristics under various LOSs, especially for frequent and non-urgent groups with shorter stays in the ED. With two datasets from the first half-years of 2009 and 2010 containing 40,849 and 43,708 records respectively, we verify the stability and robustness of the proposed approach. We confirm the qualified rules based on patient characteristics and treatment information extracted by the decision tree induction method for the patient population that primarily causes ED overcrowding—patients with non-urgent conditions and short ED stays—in terms of accuracy, medical clinical value and relatedness. We identify that patients with short LOSs demonstrated similar characteristics in visiting ED. We also identify that attributes such as treatment frequencies of laboratory testing, age, and mode of arrival are good indicators for predicting patients’ LOSs. The results clarify ED crowding in Taiwan and can guide investigations of ED overcrowding from the perspective of generalizing characteristics of visits. The results serve as a reference model for related ED research in a similar context for clinical decision support.Keywords: Clinical Decision Support; ED Overcrowding; Hybrid Data Mining; Length of Stay; Patient Characteristics

Choosing Video Instead of In-Clinic Consultations in Primary Care in Israel: Discrete Choice Experiment Among Key Stakeholders—Patients, Primary Care Physicians, and Policy Makers

BackgroundDespite its innovative benefits, the adoption of video consultations (VCs) in primary care settings is complex and slow. ObjectivesTo quantify the preferences of key stakeholders in Israel's primary care—patients, primary care practitioners, and policy makers—regarding VCs compared with traditional in-clinic consultations (ICC) in nonurgent conditions. MethodsDiscrete choice experiment surveys were completed by 508 patients, 311 physicians, and 141 policy makers. These consisted of 12 choice tasks of 2 labeled alternatives (VC or ICC), with the 4 attributes most relevant to each stakeholder group. A random effects logit model analysis was used to estimate stakeholders' preferences. ResultsAll 4 experiments' attributes were significantly important in choosing VC versus ICC for the patient group and the physician group. Three out of 4 attributes were significantly important to policy makers. Differences and similarities between stakeholders were identified in attribute rank order, trade-offs, and VC uptake probabilities. Policy makers' VC uptake rate was 86%. Patients' preferences suggested that 68% of ICCs could be replaced by VCs. Physicians' VC uptake was 30% in cases in which the consultation purpose was to diagnose and provide treatment and 48% in cases in which the consultation purpose was follow-up. ConclusionsOur findings show key stakeholders' preferences about VC integration, to be considered when these systems are introduced into primary care and optimize the implementation process. Although there is a stronger preference for ICC among physicians and patients, alternative combinations of attribute levels might be used to compensate and reconfigure a more preferred VC service.

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group.

Adolescents with autism spectrum disorder (ASD) and/or intellectual disability (ID) may utilize the emergency department (ED) more frequently than individuals in the general population. This study compared ED utilization and charges during adolescence among four groups of individuals: ASD-only, ASD + ID, ID-only, and a population comparison (PC) group. ED visits occurring during age 12-17 years were examined to identify non, low, and high utilizers. Logistic regression was used to compare groups on the odds of having at least one ED visit during adolescence. Generalized linear models were used to compare groups on number of ED visits and total charges, stratified by low and high ED utilization. Descriptive examination of presenting diagnoses was performed. Individuals with ID, with or without co-occurring ASD, were significantly more likely to have at least one ED visit during adolescence. Among high ED utilizers, the ID-only group had the most frequent ED visits but had significantly lower charges than the ASD-only group. Individuals with ASD-only and ASD + ID differed from the ID-only and PC groups in presenting diagnoses. No differences between groups in number of ED visits or charges were observed among low utilizers. ID, with or without ASD, increased the odds of visiting the ED during adolescence. Adolescents with ID-only had the most frequent ED visits, but individuals with ASD-only had the highest ED charges and tended to be seen for psychiatric concerns. Further research is warranted to better characterize and meet the healthcare needs of individuals with ASD and/or ID during adolescence. Autism Res 2019, 12: 1129-1138. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Frequent emergency department (ED) visits strain medical resources and are costlier than primary and urgent care. Our findings show that adolescents with intellectual disability (ID) may use the ED frequently for nonurgent conditions. Adolescents with autism spectrum disorder, without ID, use the ED less frequently but incur higher charges. Further research is needed to understand how to meet the unique needs of these populations in primary care to prevent overuse of the ED.

Inappropriate use of the emergency department for nonurgent conditions: Patient characteristics and associated factors at a Japanese hospital.

BackgroundThe purpose of this study was to investigate the primary factors associated with inappropriate out‐of‐hours emergency department (ED) use by patients with nonurgent conditions.MethodsWe compared patients with nonurgent conditions who made inappropriate, out‐of‐hours ED visits to patients who visited an acute care hospital during daytime consultation hours between May 30 and October 16, 2014, in terms of patient characteristics and reasons for consultation. Our goal was to identify factors associated with inappropriate ED use, defined as an out‐of‐hours, nonurgent, and unnecessary visits.ResultsWe analyzed data from 84 patients who made inappropriate use of out‐of‐hours emergency care and 147 patients who sought care during regular consultation hours. In the inappropriate use group, “desire to be cured quickly” was the most common reason. Acute upper respiratory infection, acute gastroenteritis, and primary headache comprised 51.1% of diagnoses in the inappropriate use group. One factor associated with inappropriate use was two or more previous out‐of‐hours ED visits (odds ratio (OR) 3.19; 95% confidence interval (CI) 1.22‐8.31) (reference: 0 visits).ConclusionsPatients with two or more previous out‐of‐hours ED visits were more than three times as likely to inappropriately use the ED compared to patients who had not visited the ED at all in the past 3 years.

Compliance with pathology testing guidelines in Australian general practice: protocol for a secondary analysis of electronic health record data

IntroductionIn Australia, general practitioners usually are the first point of contact for patients with non-urgent medical conditions. Appropriate and efficient utilisation of pathology tests by general practitioners forms a key...

Investigating the referral of patients with non-urgent conditions to a regional Australian emergency department: a study protocol

BackgroundAustralia’s only island state, Tasmania, experiences one of the nation’s highest incidences of non-urgent emergency department (ED) presentations in a healthcare system regularly faced with service demands that exceed resource availability. Service-demand mismatches are acknowledged to contribute to ED crowding which in turn, has been documented to have a correlation with poorer patient outcomes. Crowding within EDs is complex, non-urgent presentations alone are not the primary cause, but have been reported to be a contributing factor. In 2015–16 Tasmania recorded over 153,000 ED attendances, 55% of these fell into the two least urgent triage categories. Recent research in the State’s North established that 29% of non-urgent presentations were referred, formally or informally, from primary healthcare providers and that, for many patients (39%), the ED was not their first choice of service provider. This study aims to identify the service needs of patients referred to a regional Australian ED and subsequently triaged as non-urgent.MethodIn order to achieve this aim, three objectives have been identified. The first two objectives use an explanatory sequential mixed-method approach while the third objective will incorporate an implementation science approach. These three objectives are: first, a retrospective analysis of seven years of routinely collected hospital data to identify trends in referral of patients with non-urgent conditions; second, focus group interviews with patients and primary care providers to further understand perceived need and service requirements of those referred to the ED, and third, translation of findings into local health service recommendations.DiscussionIdentification of the needs of patients referred to the ED with non-urgent conditions will inform future service planning aiming to facilitate access to the right service at the right time and in the right place.

Telemedicine-based physician consultation results in more patients treated and released by ambulance personnel.

We examined whether teleconsultation from ambulances to a physician at an emergency medical communication center (EMCC) would increase the proportion of patients with nonurgent conditions being treated and released on site. This research was a before-after pilot study. In the intervention period, the EMCC was manned 24/7 with physicians experienced in emergency care. Eligible participants included all patients with nonurgent conditions receiving an ambulance after a medical emergency call. Ambulance personnel assessed patients and subsequently performed a telephone consultation from the ambulance with the physician. The primary outcome was the proportion of patients treated and released on site. Secondary outcomes were the number of hospital admissions, mortality, and patient satisfaction. The intervention period was compared with a corresponding control period from the previous year. We observed an increase in the proportion of patients treated and released in the intervention period in 2014 compared with the control period in 2013, up from 21% (n=137) to 29% (n=221) (odds ratio=1.46; 95% confidence interval=1.14-1.89, P=0.002). The follow-up rate was 100%. There was no observable increase in hospital admissions or mortality among patients treated and released from 2013 to 2014. A telephone survey of patients treated and released showed that 98.4% (95% confidence interval=91.3-99.9) were very satisfied or satisfied with their treatment. Teleconsultation between a physician at the EMCC and ambulance personnel and noncritically ill 1-1-2 patients results in an increased rate of patients treated and released with high satisfaction. The approach does not seem to compromise patient safety.

Primary care professionals providing non-urgent care in hospital emergency departments.

In many countries emergency departments (EDs) are facing an increase in demand for services, long waits, and severe crowding. One response to mitigate overcrowding has been to provide primary care services alongside or within hospital EDs for patients with non-urgent problems. However, it is unknown how this impacts the quality of patient care and the utilisation of hospital resources, or if it is cost-effective.This is the first update of the original Cochrane Review published in 2012. To assess the effects of locating primary care professionals in hospital EDs to provide care for patients with non-urgent health problems, compared with care provided by regularly scheduled emergency physicians (EPs). We searched the Cochrane Central Register of Controlled Trials (the Cochrane Library; 2017, Issue 4), MEDLINE, Embase, CINAHL, PsycINFO, and King's Fund, from inception until 10 May 2017. We searched ClinicalTrials.gov and the WHO ICTRP for registered clinical trials, and screened reference lists of included papers and relevant systematic reviews. Randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series studies that evaluated the effectiveness of introducing primary care professionals to hospital EDs attending to patients with non-urgent conditions, as compared to the care provided by regularly scheduled EPs. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We identified four trials (one randomised trial and three non-randomised trials), one of which is newly identified in this update, involving a total of 11,463 patients, 16 general practitioners (GPs), 9 emergency nurse practitioners (NPs), and 69 EPs. These studies evaluated the effects of introducing GPs or emergency NPs to provide care to patients with non-urgent problems in the ED, as compared to EPs for outcomes such as resource use. The studies were conducted in Ireland, the UK, and Australia, and had an overall high or unclear risk of bias. The outcomes investigated were similar across studies, and there was considerable variation in the triage system used, the level of expertise and experience of the medical practitioners, and type of hospital (urban teaching, suburban community hospital). Main sources of funding were national or regional health authorities and a medical research funding body.There was high heterogeneity across studies, which precluded pooling data. It is uncertain whether the intervention reduces time from arrival to clinical assessment and treatment or total length of ED stay (1 study; 260 participants), admissions to hospital, diagnostic tests, treatments given, or consultations or referrals to hospital-based specialist (3 studies; 11,203 participants), as well as costs (2 studies; 9325 participants), as we assessed the evidence as being of very low-certainty for all outcomes.No data were reported on adverse events (such as ED returns and mortality). We assessed the evidence from the four included studies as of very low-certainty overall, as the results are inconsistent and safety has not been examined. The evidence is insufficient to draw conclusions for practice or policy regarding the effectiveness and safety of care provided to non-urgent patients by GPs and NPs versus EPs in the ED to mitigate problems of overcrowding, wait times, and patient flow.

Changing Trends in Eye-Related Complaints Presenting to the Emergency Department in Beirut, Lebanon, over 15 Years.

Objective To report the 15-year trend in ophthalmic presentations to the emergency department (ED) at the only medical center in Lebanon that provides 24-hour ophthalmologic care. Methods Retrospective review of 1967 patients presenting to the ED with eye-related complaints between September 1997 and August 1998 and between September 2012 and August 2013. Diagnoses were classified into 4 categories according to the International Society of Ocular Trauma and include penetrating eye injuries, nonpenetrating eye trauma, nontraumatic ophthalmic emergencies, and nontraumatic, nonurgent ophthalmic conditions. Results One thousand sixty eye-related presentations out of 39,158 total ED visits (2.71%) presented in 1997 compared to 907 out of 46,363 in 2012 (1.96%). Penetrating and nonpenetrating eye emergencies decreased between 1997 and 2012 (7.17% to 4.19%, p = 0.003 and 52.64% to 29.00%, p < 0.001, resp.) while nonurgent cases increased from 30.19% to 53.47% (p < 0.001). 57% of patients were covered by third-party guarantors in 1997 versus 73% in 2012. Conclusion Our results demonstrate a significant increase in nonurgent cases in parallel with the proportion of third-party payers, an issue to be addressed by public health policies and proper resource allocation. A detailed nationwide review is needed to make solid recommendations for the management of ophthalmologic presentations in the ED.

Low-Income Senior Housing Residents’ Emergency Department Use and Care Transition Problems

Older adults may be at risk of adverse outcomes after emergency department (ED) visits due to ineffective transitions of care. Semi-structured interviews were employed to identify and categorize reasons for ED use and problems that occur during transition from the ED back to home among 14 residents of low-income senior housing. Qualitative thematic and descriptive analyses were used. Ambulance use, timely ED use or a wait-and-see approach, and lack of health-care provider contact before ED visit were emergent themes. Delayed medication receipt, no current medication list, and medication knowledge gaps were identified. Lack of a personal health record, follow-up care instruction, and worsening symptoms education emerged as transition problems from ED to home. After an ED visit, education opportunities exist around seeing primary care providers for nonurgent conditions, follow-up care, medications, and worsening condition symptoms. Timely receipt of discharge medications and medication education may improve medication-related transition problems.

Epidemiology and Clinical Features of Septic Arthritis in Children

Background Children with acute arthritis are commonly admitted to the hospital in part due to concern for septic arthritis (SA) and its complications. Many noninfectious, non-urgent conditions are more common than SA and present similarly. The epidemiology and clinical presentation of SA influences management of patients with acute arthritis.Methods Utilizing the electronic medical record, we reviewed the charts of children (1–18 years old) with joint complaints who presented to the hospitals and clinics of one large academic health organization in the Upper Midwest from January 2011 to July 2016. Query criteria included the presenting symptom (“arthritis”, “joint swelling”, or “joint pain”), diagnosis (“arthritis”, “septic arthritis”, or “Lyme arthritis”), and/or positive synovial fluid culture. SA was confirmed when synovial bacterial culture or PCR were positive. SA was suspected in cases with a positive blood culture or when the patient was treated empirically with 4 weeks of antibiotic with no alternate diagnosis. All other children were excluded from the study cohort.ResultsOf the 705 children whose charts were reviewed, 609 were excluded with a noninfectious diagnosis and 72 with Lyme arthritis (Figure 1). We identified 24 children with SA. Six children diagnosed with SA were immunosuppressed. Among healthy children with SA, seven were diagnosed with contiguous musculoskeletal (MSK) infection and 11 were diagnosed with acute, isolated, monoarticular arthritis. SA was more common in boys. The most common pathogen isolated was S aureus (13). The knee (7) and hip (6) accounted for the majority of joints involved in healthy children.Conclusion SA is a rare cause of acute arthritis in children. In healthy children, SA may present with contiguous MSK infection or in an isolated joint. SA is more likely in boys and in the knee or hip joint. S. aureus is the most common cause of SA. Clear understanding of the epidemiology and clinical history of SA should shape clinical decision making in children with acute arthritis.Figure 1.MSK – musculoskeletal, SA – septic arthritis, OM – osteomyelitis, DVT – deep venous thrombosis, Cx – culture negative.Disclosures All authors: No reported disclosures.

Welche Patienten kommen mit nicht dringlichen Augenproblemen in die Notaufnahme?

Stagg BC et al. Factors affecting visits to the emergency department for urgent and nonurgent ocular conditions. Ophthalmology 2017; 124: 720 – 729

The danish regions pediatric triage model has a limited ability to detect both critically ill children as well as children to be sent home without treatment \u2013 a study of diagnostic accuracy

BackgroundThe Danish Regions Pediatric Triage model (DRPT) was introduced in 2012 and subsequent implemented in most Danish acute pediatric departments. The aim was to evaluate the validity of DRPT as a screening tool to detect both the most serious acute conditions and the non-serious conditions in the acute referred patients in a pediatric department.MethodThe study was prospective observational, with follow-up on all children with acute referral to pediatric department from October to December 2015. The DRPT was evaluated by comparison to a predefined reference standard and to the actual clinical outcomes: critically ill children and children returned to home without any treatment. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and likelihood for positive and negative test were calculated.ResultsFive hundred fifty children were included. The DRPT categorized 7% very urgent, 28% urgent, 29% standard and 36% non-urgent. The DRPT was equal to the reference standard in 31% of the children (CI: 27-35%). DRPT undertriaged 55% of the children (CI: 51-59%) and overtriaged 14% of the children (CI: 11-17%). For the most urgent patients the sensitivity of DRPT was 31% (CI: 20-48%) compared to the reference standard and 20% (CI: 7-41) for critically ill. For children with non-urgent conditions the specificity of DRPT was 66% (CI: 62-71%) compared to the reference standard and 68% (CI: 62-75%) for the children who went home with no treatment. In none of the analyses, the likelihood ratio of the negative test was less than 0.7 and the positive likelihood ratio only reached more than 5 in one of the analyses.DiscussionThis study is the first to evaluate the DRPT triage system. From the very limited validity studies of other well-established triage systems, it is difficult to judge whether the DRPT performs better or worse than the alternatives. The DRPT errs to the undertriage side. If the sensitivity is low, a number of the sickest children are undetected and this is a matter of concern.ConclusionThe DRPT is a triage tool with limited ability to detect the critically ill children as well as the children who can be returned to home without any treatment.Trial registrationNot relevant