Clinical Considerations When Applying Vital Signs in Pediatric Korean Triage and Acuity Scale

Abstract

Initial vital signs of children at the emergency department may be abnormal because of anxiety and irritability, resulting in unrealistic triage levels. This study aimed to evaluate the effectiveness of pediatric triage by clinical decision based on the patient's general condition. The Pediatric Korean Triage and Acuity Scale (PedKTAS) has been used nationwide for triage since 2016. The triage level, as assessed by an experienced triage nurse and based on the patient's clinical condition, was defined as the ‘real practice (RP)-level,’ while the re-calculated triage level, as assessed by the direct application of initial vital signs, was defined as the ‘simulation (S)-level.’ A total of 22,841 patients were triaged during the study period. The hospitalization rate according to RP-PedKTAS levels exhibited a significant correlation with the expected hospitalization rate suggested by the Pediatric Canadian Triage and Acuity Scale (CTAS) (P = 0.002), whereas the S-PedKTAS levels did not (P = 0.151). Compared with the previously reported pediatric CTAS level-specific hospitalization rate and intensive care unit (ICU) admission rate, RP-PedKTAS was significantly correlated with both hospitalization rate and ICU admission rate (P = 0.001 and P = 0.012, respectively). However, S-PedKTAS showed no significant correlation in both (P = 0.267 and P = 0.188, respectively). The determination of triage levels based on clinical decision rather than the direct application of abnormal initial vital signs to PedKTAS is more accurate in predicting the hospitalization rate and ICU admission rate.

Artificial intelligence algorithm to predict the need for critical care in prehospital emergency medical services

“…A major limitation of conventional triage tools is their low accuracy at the middle level [18,33,34]. As shown in Fig.…”

“…It is based on the severity of patients' healthcare problems and the number of resources that is anticipated to require. KTAS was developed in 2012 based on the Canadian Triage and Acuity Scale and has been used nationwide as a triage since 2016 in Korea [11,17,18]. KTAS is a five-level ED triage algorithm that considers symptoms, pain, and physiological values.…”

“…The AUC is a frequently used metric and shows the sensitivity against 1-specificity [22]. Based on previous studies, we used levels 1-2, levels 1-2, points 3-14, and points 5-20 to predict the critical care with the ESI, KTAS, MEWS, and NEWS, respectively [11,[17][18][19][20][21]. When evaluating the continuous score predicted by the AI algorithm, we fixed the sensitivity as 0.8.…”

Admission Decisions Made by Emergency Physicians Can Reduce the Emergency Department Length of Stay for Medical Patients

“…e data that were extracted from the hospital information system database included the age, sex, ED LOS, admitted unit (either general ward or intensive care unit), admitted department and subspecialty, discharged department and division, hospital LOS, and the Korean Triage and Acuity Scale (KTAS) score from all the patients from the ED admitted to the IM department. KTAS is a modified assessment tool based on the Canadian Triage and Acuity Scale (CTAS) that was adapted for the Korean medical environment [21][22][23]. When the admitted department/division was different from the discharged department/division, the patient was considered an interdepartmental transfer.…”

Triage methods in children, a systematic review

“…Triage is one of the emergency management units that can realize the diagnosis of an emergency (6). In fact, the triage will create a kind of justice in the allocation of emergency facilities based on the patient's acuity and conditions (7) which can slow down the patient's illness and minimize the incidence of medical errors (8,9). For this reason, the presence of new methods of triage has increased significantly over the past few years (10).…”