Pediatric Triage Research Articles

A Low-Cost, Low-Tech Virtual Mass Casualty Training Simulation for Undergraduate Medical Education.

Mass casualty incident (MCI) training effectively increases trainees' knowledge and confidence when implemented in a live, in-person setting. In-person MCI training is resource-intensive, but virtual MCI training models are an alternative with similar effectiveness at a lesser cost. However, most of these validated virtual options are based on high-tech virtual reality (VR) programs. We designed and implemented a low-tech, low-cost virtual MCI training model for third-year medical students, using Google JamboardTM (Google, Mountain View, CA) and ZoomTM(Zoom Video Communications, Inc., San Jose, CA) as the primary technological platforms. Learners were instructed on the adult simple triage and rapid treatment (START) and the pediatric JumpSTART triage algorithms over ZoomTM. In small groups, students used a gameboard on Google JamboardTM to simulate a scene at an MCI where they were tasked with triaging 25 patients in 30 minutes, followed by a debriefing session. Students were surveyed on their perceived understanding of the triage algorithms and confidence before and after the event using a 5-point Likert scale (poor, fair, good, very good, and excellent). Pre- and post-event scores were compared using paired, two-sample, and two-tailed t-tests. We considered a p value of <0.01 significant to correct for multiplicity using the Bonferroni method. Learners reported an increased understanding of the triage algorithms (adult and pediatric), scene setup, andunderstanding of emergency medical servicetraining/transportation, as well as increased confidence in participating in an MCI (all p < 0.001). Virtual MCI training can be used as an alternative or supplement to in-person MCI training. Low-tech virtual MCI training models can increase the accessibility of these valuable training activities without sacrificing the quality of learning. Areas for further investigation include low-tech virtual MCI training models' ability to effectively recreate situational and environmental distractions and other challenges better simulated by in-person and high-tech VR training events.

Prioritizing Pediatric Emergency Triage—Sorting Out the Challenges

Prioritizing Pediatric Emergency Triage—Sorting Out the Challenges

Emergency Severity Index Version 4 and Triage of Pediatric Emergency Department Patients

Most emergency departments (EDs) across the US use the Emergency Severity Index (ESI) to predict acuity and resource needs. A comprehensive assessment of ESI accuracy among pediatric patients is lacking. To assess the frequency of mistriage using ESI (version 4) among pediatric ED visits using automated measures of mistriage and identify characteristics associated with mistriage. This cohort study used operational measures for each ESI level to classify encounters as undertriaged, overtriaged, or correctly triaged to assess the accuracy of the ESI and identify characteristics of mistriage. Participants were pediatric patients at 21 EDs within Kaiser Permanente Northern California from January 1, 2016, to December 31, 2020. During that time, version 4 of the ESI was in use by these EDs. Visits with missing ESI, incomplete ED time variables, patients transferred from another ED, and those who left against medical advice or without being seen were excluded. Data were analyzed between January 2022 and June 2023. Assigned ESI level. Rates of undertriage and overtriage by assigned ESI level based on mistriage algorithm, patient and visit characteristics associated with undertriage and overtriage. This study included 1 016 816 pediatric ED visits; the mean (SD) age of patients was 7.3 (5.6) years, 479 610 (47.2%) were female, and 537 206 (52.8%) were male. Correct triage occurred in 346 918 visits (34.1%; 95% CI, 34.0%-34.2%), while overtriage and undertriage occurred in 594 485 visits (58.5%; 95% CI, 58.4%-58.6%) and 75 413 visits (7.4%; 95% CI, 7.4%-7.5%), respectively. In adjusted analyses, undertriage was more common among children at least 6 years old compared with those younger 6 years; male patients compared with female patients; patients with Asian, Black, or Hispanic or other races or ethnicities compared with White patients; patients with comorbid illnesses compared with those without; and patients who arrived by ambulance compared with nonambulance patients. This multicenter retrospective study found that mistriage with ESI version 4 was common in pediatric ED visits. There is an opportunity to improve pediatric ED triage, both in early identification of critically ill patients (limit undertriage) and in more accurate identification of low-acuity patients with low resource needs (limit overtriage). Future research should include assessments based on version 5 of the ESI, which was released after this study was completed.

External validation of a paediatric Smart triage model for use in resource limited facilities.

Models for digital triage of sick children at emergency departments of hospitals in resource poor settings have been developed. However, prior to their adoption, external validation should be performed to ensure their generalizability. We externally validated a previously published nine-predictor paediatric triage model (Smart Triage) developed in Uganda using data from two hospitals in Kenya. Both discrimination and calibration were assessed, and recalibration was performed by optimizing the intercept for classifying patients into emergency, priority, or non-urgent categories based on low-risk and high-risk thresholds. A total of 2539 patients were eligible at Hospital 1 and 2464 at Hospital 2, and 5003 for both hospitals combined; admission rates were 8.9%, 4.5%, and 6.8%, respectively. The model showed good discrimination, with area under the receiver-operator curve (AUC) of 0.826, 0.784 and 0.821, respectively. The pre-calibrated model at a low-risk threshold of 8% achieved a sensitivity of 93% (95% confidence interval, (CI):89%-96%), 81% (CI:74%-88%), and 89% (CI:85%-92%), respectively, and at a high-risk threshold of 40%, the model achieved a specificity of 86% (CI:84%-87%), 96% (CI:95%-97%), and 91% (CI:90%-92%), respectively. Recalibration improved the graphical fit, but new risk thresholds were required to optimize sensitivity and specificity.The Smart Triage model showed good discrimination on external validation but required recalibration to improve the graphical fit of the calibration plot. There was no change in the order of prioritization of patients following recalibration in the respective triage categories. Recalibration required new site-specific risk thresholds that may not be needed if prioritization based on rank is all that is required. The Smart Triage model shows promise for wider application for use in triage for sick children in different settings.

Outcomes of Chengdu Pediatric Emergency Triage Criteria: A Retrospective Study of 198,628 Pediatric Patient Records.

BACKGROUND The Chengdu pediatric emergency triage criteria were developed at our hospital and consist of 4 triage levels: immediate treatment (level 1), treatment within 10 min (level 2), treatment within 30 min (level 3), and treatment within 240 min (level 4). This study aimed to evaluate outcomes from the levels 1 to 4 of this triage criteria. MATERIAL AND METHODS A self-designed survey form was used to collect pediatric Emergency Department (ED) patients' general data, including age, sex, and chief concern, and clinical data, including triage level, whether the patient had died, and whether the patient was admitted to our hospital. A total of 198,628 patient records that were triaged during January to May 2022 using Chengdu pediatric emergency triage criteria were included in this retrospective study. The numbers of patients triaged to levels 1, 2, 3, and 4 were 128, 1164, 14,560, and 182,776, respectively. RESULTS Statistically significant differences were found in waiting time for treatment, hospital admission rates, admission conversion rates, and case mix index at admission under different triage levels. The higher the triage priority level, the shorter the waiting time for ED treatment, higher the hospital admission and admission conversion rates, and higher case mix index value. CONCLUSIONS The Chengdu pediatric emergency triage criteria developed and applied within our hospital appears to be characterized by good clinical validity. Equipped with this triage criteria, triage nurses are more capable of determining the severity and emergency of the pediatric ED patients' health conditions and effectively triaging the patients.

Estimation of racial and language disparities in pediatric emergency department triage using statistical modeling and natural language processing.

The study aims to assess racial and language disparities in pediatric emergency department (ED) triage using analytical techniques and provide insights into the extent and nature of the disparities in the ED setting. The study analyzed a cross-sectional dataset encompassing ED visits from January 2019 to April 2021. The study utilized analytical techniques, including K-mean clustering (KNN), multivariate adaptive regression splines (MARS), and natural language processing (NLP) embedding. NLP embedding and KNN were employed to handle the chief complaints and categorize them into clusters, while the MARS was used to identify significant interactions among the clinical features. The study also explored important variables, including age-adjusted vital signs. Multiple logistic regression models with varying specifications were developed to assess the robustness of analysis results. The study consistently found that non-White children, especially African American (AA) and Hispanic, were often under-triaged, with AA children having >2 times higher odds of receiving lower acuity scores compared to White children. While the results are generally consistent, incorporating relevant variables modified the results for specific patient groups (eg, Asians). By employing a comprehensive analysis methodology, the study checked the robustness of the analysis results on racial and language disparities in pediatric ED triage. The study also recognized the significance of analytical techniques in assessing pediatric health conditions and analyzing disparities. The study's findings highlight the significant need for equal and fair assessment and treatment in the pediatric ED, regardless of their patients' race and language.

Reverse shock index multiplied by the motor component of the Glasgow Coma Scale predicts mortality and need for intervention in pediatric trauma patients.

Timely identification of high-risk pediatric trauma patients and appropriate resource mobilization may lead to improved outcomes. We hypothesized that reverse shock index times the motor component of the Glasgow Coma Scale (GCS) (rSIM) would perform equivalently to reverse shock index times the total GCS (rSIG) in the prediction of mortality and the need for intervention following pediatric trauma. The 2017-2020 National Trauma Data Bank data sets were used. We included all patients 16 years or younger who had a documented prehospital and trauma bay systolic blood pressure, heart rate, and total GCS. We excluded all patients who arrived at the trauma center without vital signs and interfacility transport patients. Receiver operating characteristic curves were used to model the performance of each metric as a classifier with respect to our primary and secondary outcomes, and the area under the receiver operating characteristic curve (AUROC) was used for comparison. Our primary outcome was mortality before hospital discharge. Secondary outcomes included blood product administration or hemorrhage control intervention (surgery or angiography) <4 hours following hospital arrival and intensive care unit admission. After application of exclusion criteria, 77,996 patients were included in our analysis. Reverse shock index times GCS-motor and rSIG performed equivalently as predictors of mortality in the 1- to 2- ( p = 0.05) and 3- to 5-year-old categories ( p = 0.28), but rSIM was statistically outperformed by rSIG in the 6- to 12- (AUROC, 0.96 vs. 0.95; p = 0.04) and 13- to 16-year-old age categories (AUROC, 0.96 vs. 0.95; p < 0.01). Reverse shock index times GCS-motor and rSIG also performed similarly with respect to prediction of secondary outcomes. Reverse shock index times GCS-total and rSIM are both outstanding predictors of mortality following pediatric trauma. Statistically significant differences in favor of rSIG were noted in some age groups. Because of the simplicity of calculation, rSIM may be a useful tool for pediatric trauma triage. Diagnostic Tests or Criteria; Level III.

Use of a statewide solid organ injury procotcol to optimize triage, treatment, and transfer for pediatric abdominal trauma.

The Utah Pediatric Trauma Network (UPTN) is a non-competitive collaboration of all 51 hospitals in the state of Utah with the purpose of improving pediatric trauma care. Created in 2019, UPTN has implemented evidence-based guidelines based on hospital resources and capabilities with quarterly review of data collected in a network-specific database. A blunt solid organ injury (SOI) protocol was developed to optimize treatment of these injuries statewide. The purpose of this study was to review the effectiveness of the SOI guideline. The UPTN REDCap® database was retrospectively reviewed from 2021 through 2022. We compared admissions from the Level 1 pediatric trauma center (PED1) to non-pediatric hospitals (non-PED1) of children with low-grade (I-II) and high-grade (III-V) SOIs. In 2 years, 172 patients were treated for blunt SOI, with or without concomitant injuries. There were 48 (28%) low-grade and 124 (72%) high-grade SOIs. 33 (69%) patients were triaged with low-grade SOI injuries at a non-PED1 center, and 17 (35%) were transferred to the PED1 hospital. Most had multiple injuries, but 7 (44%) were isolated, and none required a transfusion or any procedure/operation at either hospital. Of the 124 patients with high-grade injuries, 41 (33%) primarily presented to the PED1 center, and 44 (35%) were transferred there. Of these, 2 required a splenectomy and none required angiography. Thirty-nine children were treated at non-PED1 centers without transfer, and 4 required splenectomy and 6 underwent angiography/embolization procedures. No patient with an isolated SOI died. Implementation of SOI guidelines across UPTN successfully allowed non-pediatric hospitals to safely admit children with low-grade isolated SOI, keeping families closer to home, while standardizing pediatric triage for blunt abdominal trauma in the state. Therapeutic/Care Management; Level IV.

A low proportion of undertriage validates the new West coast system for triage-Paediatric.

There is a lack of studies on paediatric triage systems. This study aimed to evaluate patient safety of the Gothenburg-developed paediatric triage system West Coast System for Triage-Paediatric (WEST-P). This study was performed at the paediatric emergency department in Gothenburg, Sweden, October 2020 to April 2021. Included patients were double-triaged with the WEST-P, and the established Rapid Emergency Triage and Treatment System-Paediatrics (RETTS-p). We compared the level of urgency between both systems to identify potentially undertriaged patients. Also, we assessed the patient safety according to clinical assessment at presentation, and pre-defined criteria. This study included 2290 (23%) of triaged patients (44% girls, median age: 5.0 years) during the study period. A higher number of patients triaged to low urgency in WEST-P compared to RETTS-p (p < 0.0001) was observed, and 497 cases with low WEST-P and high RETTS-p urgencies identified. Of these, 29 had a clinical assessment indicating high urgency. After patient safety assessment, seven (0.4%) were determined undertriaged by the new triage system WEST-P. Our findings demonstrate a low risk of undertriage in the new WEST-P. Thus, the WEST-P has a high degree of patient safety when used in a paediatric emergency department.

Pediatric Life Support in Prehospital Emergency Medicine: An Empirical Investigation in the Context of Taiwan's Critical Shortage of Pediatric Emergency Specialists.

This study aims to facilitate parental identification of designated emergency facilities for expeditious pediatric care within the framework of Taiwan's newly implemented "regional joint defense" approach to pediatric emergency services. The research seeks to elucidate the mechanisms by which this novel system can enhance timely access to appropriate emergency care for children, potentially improving health outcomes and resource utilization in acute pediatric situations. Factor analysis (FA) and triangular entropy matrix (TEM) analyzed the appearance, breathing and skin of pediatric assessment triangle (ABC of PAT), three types of prehospital pediatric emergence condition (PPEC), five levels of Taiwan's pediatric emergency triage (TPET), and applied the social learning theory (SLT) in educational doctrine, using experts' weighted questionnaires. Firstly, to address deficiencies in Taiwan's pediatric prehospital emergency medicine (PEM) system, integrating emergency medical knowledge (EMK) and pediatric life support (PLS) into medical education, staff training, and the national handbook for new parents is crucial. This equips parents to manage children's illnesses and prevent emergencies. Then, in life-threatening situations, immediate emergency room (ER) transport is vital for symptoms like whitish or purple lips, cold limbs, mottled skin, cold sweat, convulsions, dyspnea, chest dimples, weak consciousness, and oxygen saturation below 94%. Finally, for non-life-threatening emergencies, seek medical evaluation if symptoms include wheezing, chest tightness, chest pain, persistent high fever over 39 degrees with convulsions, chills, cold sweats, not eating or urinating for over 12 hours, or fever lasting more than 48 hours. Parents must remain calm and provide their baby with a sense of security while observing the development of physical symptoms. This approach enables them to effectively determine the most appropriate time to take their children to the emergency room, thereby avoiding life-threatening emergencies. Prompt and proper measures and treatments not only alleviate various discomforts caused by illness or medical emergencies but also reduce systemic distress, life-threatening situations, and unfortunate incidents before hospitalization.

Efektifitas Penerapan Aplikasi Pediactric Triage Metode Jumpstart terhadap Penanganan Awal Kegawatdaruratan pada Anak

Accidents involving students must be handled quickly and appropriately so that the readiness of teachers and employees at school is needed. One of the initial treatment methods in emergency cases is the pediatric triage Jumpstart method. This study aims to determine the effectiveness of using the pediatric triage Jumpstart method application on emergency management readiness in students of SDN 023 Kampung Baru, Luyo District, Polewali Mandar Regency. A population of 28 people using the purposive sampling method of 25 people are teachers and employees who are active at SDN 023 Kampung Baru, the research method uses experimental design with a pre and posttest one group design approach. To measure research variables using questionnaire instruments and observation sheets. The results of the study using a marginal homogenity test to determine the effectiveness of using the pediatric triage application of the Jumpstart method on the initial treatment of emergencies in students obtained a p value of 0.001 &lt; 0.05.

Challenges in handling a civilian mass pediatric disaster during flood relief in a partially inundated armed forces medical facility.

Armed forces hospitals are often called upon to provide medical aid to civilians during natural calamities. Though children are often the most vulnerable segment of population in these events, research that addresses their unique needs and the role of armed forces hospitals remains sparse. We examined pediatric morbidity and mortality at a flooded armed forces hospital. Factors that affected outcomes were identified. 158 patients were evacuated en masse from a children's hospital in northern India that was submerged by flood to an adjacent partially inundated armed forces hospital specializing in military medicine and adult trauma. The children were provided case-based clinical care as per existing disaster management protocol. Geoclimatic vulnerability factors, morbidity/mortality, and medical and logistical challenges for future intervention were investigated. One pediatrician who provided initial triage was joined by two others after 48 hours. A limited load of adult patients permitted more resources for the children, majority (49 percent) of whom were neonates. Intensive care was necessitated for 32 (20.2 percent) cases, with half managed in adult ICU. Overall in-hospital mortality was 5.7 percent. Experienced staff, cross-specialty multitasking, and innovative and noncensorious leadership were identified as assets amidst resources compromised by flooding. Clear delineation of primary caregiver role of pediatrician at outset, pediatric emergency care training, pediatric triage, resource allocation for thermoregulation, oxygen therapy and ventilation, earmarking centers for transfer of cases, and safe transportation to the centers were identified as areas meriting further attention. Armed forces hospitals in vulnerable geoclimatic zones must address pediatric concerns in disaster management plans.

Unique triage methods in the paediatric emergency roomof a low resource setting

Introduction: Despite its importance in emergency medicine, the practice of triage in low- and middle-income countries remains rudimentary, due to dearth of human and material resources, among other reasons.&#x0D; Subjects and methods: In the Children Emergency Room of a teaching hospital, some nonclinical staff were intermittently deployed to coordinate patient traffic and provide brief first- contact triage on arrival. For this, they were internally trained in triage. The present study was aimed at assessing the value and accuracy of first-contact triage provided by nonclinical staff in a children emergency department of a tertiary hospital.&#x0D; Results: Data of 45 patients seen during the period were obtained from the records of the triage officers and included their age, gender, presenting complaints and the findings of the paediatric assessment triangle. There was a statistically significant relationship between the triage ratings of the nonCC –BY 4.0 clinical staff and the qSOFA / L- qSOFA scores obtained by the emergency room doctors, the time spent in CHER and the total duration of admission (R2= 0.36 - 0.44; p = 0.003), (R2= 0.23 - 0.28; p = 0.018) and (R2= 0.33 - 0.40; p = 0.007) respectively.&#x0D; Conclusion: This study shows that to a high degree, the nonclinical staff correctly categorized the severity of illness in the Paediatric Emergency Department of a tertiary level hospital, thus limiting undue tertiary delay in treatment and potential harm from such delays. Hence, the study exposes a potential source of human resources for paediatric emergency triage in LMICs where there is a dearth of professional medical personnel.

Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society.

Pediatric trauma triage and transfer decisions should incorporate the likelihood that an injured child will require pediatric trauma center (PTC) resources. Resource utilization may be a better basis than mortality risk when evaluating pediatric injury severity. However, there is currently no consensus definition of PTC resource utilization that encompasses the full scope of PTC services. Consensus criteria were developed in collaboration with the Pediatric Trauma Society (PTS) Research Committee using a modified Delphi approach. An expert panel was recruited representing the following pediatric disciplines: prehospital care, emergency medicine, nursing, general surgery, neurosurgery, orthopedics, anesthesia, radiology, critical care, child abuse, and rehabilitation medicine. Resource utilization criteria were drafted from a comprehensive literature review, seeking to complete the following sentence: "Pediatric patients with traumatic injuries have used PTC resources if they..." Criteria were then refined and underwent three rounds of voting to achieve consensus. Consensus was defined as agreement of 75% or more panelists. Between the second and third voting rounds, broad feedback from attendees of the PTS annual meeting was obtained. The Delphi panel consisted of 18 members from 15 institutions. Twenty initial draft criteria were developed based on literature review. These criteria dealt with airway interventions, vascular access, initial stabilization procedures, fluid resuscitation, blood product transfusion, abdominal trauma/solid organ injury management, intensive care monitoring, anesthesia/sedation, advanced imaging, radiologic interpretation, child abuse evaluation, and rehabilitative services. After refinement and panel voting, 14 criteria achieved the >75% consensus threshold. The final consensus criteria were reviewed and endorsed by the PTS Guidelines Committee. This study defines multidisciplinary consensus-based criteria for PTC resource utilization. These criteria are an important step toward developing a criterion standard, resource-based, pediatric injury severity metric. Such metrics can help optimize system-level pediatric trauma triage based on likelihood of requiring PTC resources. Diagnostic Test/Criteria; Level II.

Knowledge, Awareness, and Understanding of Pediatric Triage Among Nursing Officers in India: A Multicenter Study.

Triage is crucial in patient screening within emergency departments (EDs) worldwide. It is one of the essential and standard medical practices in many developed countries. However, in India, there is a need for improvement in triage utilization, as it is predominantly performed by resident doctors or medical officers, leading to an uneven distribution of clinical skills among healthcare providers (HCPs). A comprehensive analysis incorporating literature review and data collection revealed that while mandatory screening is conducted in most Indian EDs, the formal implementation of standardized triage protocols remains limited. Like in developed countries, registered nurses or nursing officers (NOs) can be effectively trained and directed to play the role of dedicated triage personnel in EDs of most of the healthcare facilities in India. This study aimed to examine the current state of triage utilization and its impact on the distribution of responsibilities among HCPs in Indian EDs. Through this online survey, the investigatorsassessed the knowledge and practical understanding of clinical triaging among NOs, working at various hospitals nationwide. The participants included 5,029 NOs working in various parts of India, predominantly nursing graduates (82.52%), the majority being employed in government healthcare settings (84.01%)and most having over five years of cumulative working experience in the ED (70.77%). Nurses showed inadequate knowledge and awareness about the Pediatric Assessment Triangle (PAT) used for quick initial evaluation (62.18%amongall participants). Concerning the complete triage process applicable, especially in pediatric ED settings, they had even less satisfactory knowledge and understanding, e.g., identifying primary (28.27%) and secondary (22.69%) survey components via focused history and examination, properly using temperature assessment (23.32%) and instant blood glucose level assessment (22.95%) in triage, and knowing various types of internationally accepted triage systems for ED-based health facilities such as the Emergency Severity Index (ESI), Canadian Triage and Acuity Scale (CTAS), and Australasian Triage Scale (ATS) (15.87%). ANOVA and post hoc analysis revealed that the intergroup performance of the study participants with maximum correct responses to the knowledge-determining specified subset of the questionnaire depicts the significantly higher role of graduate nursing degree over diploma such as General Nursing and Midwifery (GNM)/Auxiliary Nursing and Midwifery (ANM) qualification, working in government hospital versus private setup, and ED working experience of >5 years over that of <5 years. Of the participants in the study, 50% were not evaluated for cognitive or psychomotor domains during their assessment examinations. The research illuminated a significant disparity in knowledge and proficiency levels among Indian nurses concerning pediatric triage, especially with the ability to effectively apply the PAT for initial patient evaluations, discern components of primary and secondary surveys, and comprehend various triage systems. This study underscores the importance of comprehensive reform in the Indian healthcare system and teaching curriculum by emphasizing clinical triage training and interprofessional collaboration, and establishing guidelines and regulations to ensure consistent and standardized triage practices across all EDs.

Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda

BackgroundSepsis, characterized by organ dysfunction due to presumed or proven infection, has a case-fatality over 20% in severe cases in low-and-middle income countries. Early diagnosis and treatment have proven benefits, prompting our implementation of Smart Triage at Jinja Regional Referral Hospital in Uganda, a program that expedites treatment through a data-driven triage platform. We conducted a cost-effectiveness analysis of Smart Triage to explore its impact on patients and inform multicenter scale up.MethodsThe parent clinical trial for Smart Triage was pre-post in design, using the proportion of children receiving sepsis treatment within one hour as the primary outcome, a measure linked to mortality benefit in existing literature. We used a decision-analytic model with Monte Carlo simulation to calculate the cost per year-of-life-lost (YLL) averted of Smart Triage from societal, government, and patient perspectives. Healthcare utilization and lost work for seven days post-discharge were translated into costs and productivity losses via secondary linkage data.ResultsIn 2021 United States dollars, Smart Triage requires an annuitized program cost of only $0.05 per child, but results in $15.32 saved per YLL averted. At a willingness-to-pay threshold of only $3 per YLL averted, well below published cost-effectiveness threshold estimates for Uganda, Smart Triage approaches 100% probability of cost-effectiveness over the baseline manual triage system. This cost-effectiveness was observed from societal, government, and patient perspectives. The cost-effectiveness observed was driven by a reduction in admission that, while explainable by an improved triage mechanism, may also be partially attributable to changes in healthcare utilization influenced by the coronavirus pandemic. However, Smart Triage remains cost-effective in sensitivity analyses introducing a penalty factor of up to 50% in the reduction in admission.ConclusionSmart Triage’s ability to both save costs and avert YLLs indicates that patients benefit both economically and clinically, while its high probability of cost-effectiveness strongly supports multicenter scale up. Areas for further research include the incorporation of years lived with disability when sepsis disability weights in low-resource settings become available and analyzing budget impact during multicenter scale up.Trial registrationNCT04304235 (registered on 11/03/2020, clinicaltrials.gov).

Comparison between local and three validated triage systems in an emergency department for 2126 children under 3 months.

Triage of patients less than 3 months old was not already studied. The aim was to evaluate Paediatric Emergency Department triage in patients less than 3 months old and newborns using a local system in comparison with three validated paediatric triage systems (Canadian Triage and Acuity Scale, Manchester Triage System and Emergency Severity Index) and to determine inter-system agreement. All admissions of patients less than 3 months old admitted to the Emergency Department of the Saint Vincent University Hospital between April 2018 and December 2019 were included. The local triage system level was determined prospectively for comparison with retrospectively calculated triage levels of the validated systems. Hospitalisation rates were compared and inter-system agreements determined. Among emergency admissions, 2126 were included (55% males, mean age 45 days). Hospitalisation rate increased with priority severity as determined by all triage systems studied. Cohen's kappa showed slight agreement between the local triage system and the Canadian Triage and Acuity Scale, Emergency Severity Index and Manchester Triage System (weighted kappa = 0.133, 0.185 and 0.157 respectively). Whether prospective or retrospective triage used, the systems studied exhibited good association with hospitalisation rate for patients aged less than 3 months and newborn infants.

Reliability and validity of Chengdu pediatric emergency triage criteria: case study of a single center in China

BackgroundWe aimed to examine the reliability and validity of Chengdu pediatric emergency triage criteria in order to provide a reference for the development of pediatric emergency triage within other hospitals.MethodsWe developed Chengdu pediatric emergency triage criteria based on the conditions/symptom, vital signs, and the Pediatric Early Warning Score system within our hospital using the Delphi method in 2020. The simulation scenario triage and real-life triage which were conducted in our hospital during January - March 2021, and the retrospective study of triage records extracted from our hospital’s health information system in February 2022, were used to measure the agreement in triage decisions between the triage nurses, and between the triage nurses and the expert team.ResultsFor the 20 simulation cases, the Kappa value of triage decisions between the triage nurses was 0.6 (95% CI 0.352–0.849), and the Kappa value of triage decisions between the triage nurses and the expert team was 0.73 (95% CI 0.540–0.911). For the 252 cases in the real-life triage, the Kappa value of triage decisions between the triage nurses and the expert team was 0.824 (95% CI 0.680–0.962). For the 20,540 cases selected for the retrospective study of triage records, the Kappa value of triage decisions between the triage nurses was 0.702 (95% CI 0.691–0.713); that between Triage Nurse 1 and the expert team was 0.634 (95% CI 0.623–0.647); and that between Triage Nurse 2 and the expert team was 0.725 (95% CI 0.713–0.736). The overall agreement rate in triage decisions between the triage nurses and the expert team in the simulation scenario triage was 80%; that between the triage nurses and the expert team in the real-life triage was 97.6%; and that between the triage nurses in the retrospective study was 91.9%. In the retrospective study, the agreement rates in triage decisions between Triage Nurse 1 and the expert team, and between Triage Nurse 2 and the expert team, were 88.0% and 92.3%, respectively.ConclusionChengdu pediatric emergency triage criteria that developed within our hospital is reliable and valid, and can promote rapid and effective triage by triage nurses.

Current Disaster Triage Methods in Mass Casualty Incidents

Introduction:Triage in a disaster scenario centers around doing the greatest good for the greatest number of people. There are a variety of triage systems, and to this date there is no US national endorsement of one system because triage is a dynamic procedure and there is no fixed rule for it. The Simple Triage and Rapid Treatment (START); Sort, Assess, Life-saving interventions, Treatment/Transport (SALT); Sacco; CareFlight; JumpSTART; and Pediatric Triage Tape (PTT) triage systems are discussed with emphasis on how they perform.Method:There are approximately 20 adult and two pediatric triage systems that exist for primary disaster triage. The focus is on six primary triage systems. A literature search was performed using textbooks and original research.Results:A basic assignment to immediate, delayed, minimal, or expectant can sort a large group of casualties in a matter of minutes, but improper category assignment can lead to under-triage or over-triage.When assessed by a trained paramedic arriving at a Level 1 pediatric trauma center, SALT was found to be the most accurate triage system at 59% compared to JumpSTART, CareFlight, and TriageSieve. All triage systems exhibited under-triage rates of at least 33% and SALT had the highest over-triage rate at 6%. In another study, the START triage system was found to be 85% sensitive and 86% specific in predicting critical injury in designated trauma patients.Conclusion:Mass casualty incidents are unfortunately becoming more common as the increasing numbers of violent attacks produce an overwhelming number of victims. One triage process may not work in all disasters, but first responders should be trained to evaluate for the most critical patients in a sea of evolving patient presentations. Furthermore, randomized, controlled trials in real-world conditions are nearly impossible to perform given the specific circumstances of disasters.

Effect of Pediatric Triage Education on Nurses' knowledge and Attitude at Emergency Department

Effect of Pediatric Triage Education on Nurses' knowledge and Attitude at Emergency Department