Evaluation of the Paediatric Canadian Triage and Acuity Scale in a pediatric ED

Gouin, Serge; Gravel, Jocelyn; Amre, Devendra; Bergeron, Sylvie

doi:10.1016/j.ajem.2004.02.046

Cited by 63 publications

(62 citation statements)

References 6 publications

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“…This study is the first to focus on a specific PaedCTAS presenting complaint, and its findings agree with those from a 2001 study performed at our institution. 5 In this previous study, admission rates were 12% for urgent patients and 4% for less urgent patients, lower than the 20%-40% and 10%-20% predicted by the PaedCTAS guidelines for urgent and less urgent patients, respectively.…”

Section: Triage Validitymentioning

confidence: 99%

“…5 Nurses using a traditional paper version of PaedCTAS rely on memory or a triage chart to assign acuity levels, but have wide latitude and do not have to justify the triage level chosen. The Staturg software used in this study suggests a specific triage level based on patient information elicited by the nurse, who must justify any modification of that triage level.…”

Section: Electronic Triagementioning

confidence: 99%

“…The PaedCTAS system has not yet been validated, and only 1 relevant study has been published correlating triage levels with admission rates and interventions. 5 None of its 150 presenting complaint categories have been specifically studied.…”

Section: Introductionmentioning

confidence: 99%

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Safety of a modification of the triage level for febrile children 6 to 36 months old using the Paediatric Canadian Triage and Acuity Scale

Gravel

Manzano

Arsenault

2008

CJEM

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Objective:The Paediatric Canadian Triage and Acuity Scale (PaedCTAS) stipulates that febrile patients who are 3 to 36 months old should be triaged to the PaedCTAS 3 "urgent" category. To optimize resource use, we implemented a protocol enabling these children to be down-triaged to the PaedCTAS 4 "less urgent" category if there was no sign of toxicity. Our objective was to evaluate the safety of this triage protocol modification. Methods: This retrospective cohort study evaluated all patients triaged in an urban tertiary pediatric hospital during a 6-month period between November 22, 2005, and May 22, 2006. Data were retrieved from the emergency department (ED) database and rates of hospitalization and intensive care unit (ICU) admission were compared for 4 groups: all patients triaged as urgent (level 3), all febrile patients from 3 to 36 months old triaged as urgent (level 3), all patients triaged as less urgent (level 4) and all febrile patients aged 3 to 36 months old who were down-triaged to less urgent (level 4). Results: There were 36 285 total ED visits during the study period, including 3477 febrile children who were 3 to 36 months old. Nurses down-triaged 1869 febrile children (54%) to the level-4 (less urgent) category and left 1322 (38%) in the level-3 (urgent) category. Hospitalization rate for down-triaged febrile patients was similar to that seen for all PaedCTAS 4 patients (2.4% v. 2.8%, 95% confidence interval for difference -0.3% to 1.1%). Down-triaged patients had significantly lower admission rates than those remaining in the level-3 (urgent) category (absolute risk reduction 10.7% standard deviation 1.9%, p < 0.001). No down-triaged patient died or required ICU admission. Conclusion: Febrile children aged 6 to 36 months who have no signs of toxicity can safely be down-triaged, based on triage nurse clinical judgement, to the less urgent PaedCTAS 4 category. This modification would affect the triage level of approximately 5% of all pediatric ED visits. RÉSUMÉObjectif : Selon l'échelle canadienne de triage et de gravité pour l'urgence pédiatrique (ÉTG pédi-atrique), les patients fébriles âgés de 3 à 36 mois devraient être classés au niveau de triage III (urgent) de l'ÉTG pédiatrique. Pour optimiser l'utilisation des ressources, nous avons mis au point un ORIGINAL RESEARCH • RECHERCHE ORIGINALE PEDIATRICS

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Section: Triage Validitymentioning

confidence: 99%

Section: Electronic Triagementioning

confidence: 99%

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Safety of a modification of the triage level for febrile children 6 to 36 months old using the Paediatric Canadian Triage and Acuity Scale

Gravel

Manzano

Arsenault

2008

CJEM

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“…However, because such proxies have been extensively used to validate triage systems worldwide, [42][43][44][45] we believe this method is valid to approximate true severity of illness.…”

Section: Study Weaknesses and Strengthsmentioning

confidence: 99%

Self-Referral and Serious Illness in Children With Fever

et al. 2012

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WHAT'S KNOWN ON THIS SUBJECT: General measures discourage all self-referrals to the emergency department. For adults, selfreferral to the emergency department has been associated with nonsevere disease, whereas severity of illness of self-referred children is still unknown. WHAT THIS STUDY ADDS:One in four parents properly judged and acted on their febrile child' s illness by presentation to the emergency department on their own initiative. Measures to discourage parents from self-referral may potentially result in delayed or missed diagnoses. abstract OBJECTIVE: The goal of this study was to evaluate parents' capability to assess their febrile child' s severity of illness and decision to present to the emergency department. We compared children referred by a general practitioner (GP) with those self-referred on the basis of illness-severity markers.METHODS: This was a cross-sectional observational study conducted at the emergency departments of a university and a teaching hospital. GP-referred or self-referred children with fever (aged ,16 years) who presented to the emergency department (2006)(2007)(2008) were included. Markers for severity of illness were urgency according to the Manchester Triage System, diagnostic interventions, therapeutic interventions, and follow-up. Associations between markers and referral type were assessed by using logistic regression analysis. Subgroup analyses were performed for patients with the most common presenting problems that accompanied the fever (ie, dyspnea, gastrointestinal complaints, neurologic symptoms, fever without specific symptoms).RESULTS: Thirty-eightpercentof4609childrenwerereferredbytheirGPand 62% wereself-referred.GP-referredchildrenwere classifiedas highurgency (immediate/very urgent categories) in 46% of the cases and self-referrals in 45%. Forty-three percent of GP referrals versus 27% of self-referrals needed extensive diagnostic intervention, intravenous medication/aerosol treatment, hospitalization, or a combination of these (odds ratio: 2.0 [95% confidence interval: 1.75-2.27]). In all subgroups, high urgency was not associated with referral type. GP-referred and self-referred children with dyspnea had similar frequencies of illness-severity markers.CONCLUSIONS: Although febrile self-referred children were less severely ill than GP-referred children, many parents properly judged and acted on the severity of their child' s illness. To avoid delayed or missed diagnoses, recommendations regarding interventions that would discourage selfreferral to the emergency department should be reconsidered.

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“…Previous studies have evaluated the validity of triage tools by comparing the triage level of live patients or case scenarios with either a panel of experts, 10,[12][13][14][15] or hospital admissions or resources used. [16][17][18][19] These later studies have suggested that admission to hospital, length of stay (LOS) in the ED and resources use are appropriate proxy markers for patient severity.…”

Section: Introductionmentioning

confidence: 99%

Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital

Gravel

Manzano

Arsenault

2009

CJEM

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Objective:We evaluated the validity of the Canadian Paediatric Triage and Acuity Scale (Paed-CTAS) for children visiting a pediatric emergency department (ED). Methods: This was a retrospective study evaluating all children who presented to a pediatric university-affiliated ED during a 1-year period. Data were retrieved from the ED database. Information regarding triage and disposition was registered in an ED database by a clerk following patient management. In the absence of a gold standard for triage, admission to hospital, admission to pediatric intensive care unit (PICU) and length of stay (LOS) in the ED were used as surrogate markers of severity. The primary outcome measure was the correlation between triage level (from 1 to 5) and admission to hospital. The correlation between triage level and dichotomous outcomes was evaluated by a χ 2 test and an analysis of variance (ANOVA) was used to evaluate the association between triage level and ED LOS. Results: Over the 1-year period, 58 529 patients were triaged in the ED. The proportion admitted to hospital was 63% for resuscitation (level 1), 37% for emergent (level 2), 14% for urgent (level 3), 2% for semiurgent (level 4) and 1% for nonurgent (level 5) (p < 0.001). There was also a good correlation between triage levels and LOS and admission to PICU (both p < 0.001). Conclusion: This computerized version of PaedCTAS demonstrates a strong association with admission to hospital, admission to PICU and LOS in the ED. These results suggest that PaedCTAS is a valid tool for triage of children in a pediatric ED. RÉSUMÉObjectif : Nous avons évalué la validité de l'Échelle canadienne de triage et de gravité (ÉTG) applicable aux enfants qui se présentent à un service d'urgence pédiatrique. Méthodes : Nous avons réalisé une étude rétrospective sur tous les enfants qui se sont présentés à un service d'urgence pédiatrique d'un hôpital universitaire sur une période d'un an. Nous avons extrait des informations de la base de données du service d'urgence. Les renseignements concernant le triage et les mesures à prendre ont été consignés dans une base de données à l'urgence par un commis après la prise en charge du patient. En l'absence d'un étalon-or pour le triage, nous avons utilisé des marqueurs de substitution de la gravité à savoir l'admission à l'hôpital, l'admission à l'unité pédiatrique de soins intensifs (UPSI) et la durée du séjour à l'urgence. La principale mesure de résultats était la corrélation entre le niveau de triage (de 1 à 5) et l'admission à l'hôpital. La corrélation entre le niveau de triage et les paramètres dichotomiques a été évaluée à ORIGINAL RESEARCH • RECHERCHE ORIGINALE EM ADVANCES

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Evaluation of the Paediatric Canadian Triage and Acuity Scale in a pediatric ED

Cited by 63 publications

References 6 publications

Safety of a modification of the triage level for febrile children 6 to 36 months old using the Paediatric Canadian Triage and Acuity Scale

Safety of a modification of the triage level for febrile children 6 to 36 months old using the Paediatric Canadian Triage and Acuity Scale

Self-Referral and Serious Illness in Children With Fever

Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital

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