Performance of the Canadian Triage and Acuity Scale for Children: A Multicenter Database Study

Gravel, Jocelyn; Fitzpatrick, Eleanor; Gouin, Serge; Millar, Kelly; Curtis, Sarah; Joubert, Gary; Boutis, Kathy; Guímont, Chantal; Goldman, Ran D.; Dubrovsky, Alexander Sasha; Porter, Robert; Beer, Darcy; Doan, Quynh; Osmond, Martin H.

doi:10.1016/j.annemergmed.2012.05.024

Cited by 75 publications

(74 citation statements)

References 28 publications

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“…Worldwide, hospitalization and ICU admission have been used extensively asa proxy forseverityof illness in the ED. [33][34][35][36][37] Also, it is a limitation that vital signs were not measured in all patients. We resolved this problem by using a multiple imputation model that can be used when the outcome measure (ICU admission) and predictor (presence of vital signs) on X and Yare correlated.…”

Section: Discussionmentioning

confidence: 99%

Validity of Different Pediatric Early Warning Scores in the Emergency Department

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Pediatric early warning scores (PEWS) for hospital inpatients have been developed to identify patients at risk for deterioration. Beyond triage, similar systems that identify ill patients and predict requirements for a higher level of care are needed in the emergency department. WHAT THIS STUDY ADDS:The validity of the different PEWS in pediatric emergency care patients has never been evaluated. This study showed that PEWS are capable of detecting children in need of ICU admission. abstract OBJECTIVE: Pediatric early warning scores (PEWS) are being advocated for use in the emergency department (ED). The goal of this study was to compare the validity of different PEWS in a pediatric ED. METHODS:Ten different PEWS were evaluated in a large prospective cohort. We included children aged ,16 years who had presented to the ED of a university hospital in The Netherlands (200922012). The validity of the PEWS for predicting ICU admission or hospitalization was expressed by the area under the receiver operating characteristic (ROC) curves.RESULTS: These PEWS were validated in 17 943 children. Two percent of these children were admitted to the ICU, and 16% were hospitalized. The areas under the ROC curves for predicting ICU admission, ranging from 0.60 (95% confidence interval [CI]: 0.5720.62) to 0.82 (95% CI: 0.79-0.85), were moderate to good. The area under the ROC curves for predicting hospitalization was poor to moderate (range: 0.56 [95% CI: 0.55-0.58] to 0.68 [95% CI: 0.66-0.69]). The sensitivity and specificity derived from the ROC curves ranged widely for both ICU admission (sensitivity: 61.3%-94.4%; specificity: 25.2%-86.7%) and hospital admission (sensitivity: 36.4%-85.7%; specificity: 27.1%-90.5%). None of the PEWS had a high sensitivity as well as a high specificity.CONCLUSIONS: PEWS can be used to detect children presenting to the ED who are in need of an ICU admission. Scoring systems, wherein the parameters are summed to a numeric value, were better able to identify patients at risk than triggering systems, which need 1 positive parameter. Pediatrics 2013;132:e841-e850

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Section: Discussionmentioning

confidence: 99%

Validity of Different Pediatric Early Warning Scores in the Emergency Department

et al. 2013

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“…Clinical triage scales and scoring systems have also received considerable attention, mostly in the field of emergency medicine [2][3][4][5]. Although methodology is steadily improving [6], significant challenges remain in FDA device/drug status: Not applicable.…”

Section: Introductionmentioning

confidence: 99%

“…validation of those models [2,5] and in assessment of their performance [7]. Triage scales are especially troublesome because the impact of appropriate triage on clinical results can be hard to determine [8].…”

Section: Introductionmentioning

confidence: 99%

Validation of the Calgary Spine Severity Score

et al. 2015

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“…[2] The specific fl owchart for children with fever was added in the fourth version of ESI. [2] Canadian Triage and Acuity Scale (CTAS) [14][15][16][17][18][19] CTAS is based on a list of patients presenting complaints with fi rst-and second-order modifi ers for specifi c conditions. Its principle operational objective determines the time for the patient's initial assessment by a physician.…”

Section: Triage Systemmentioning

confidence: 99%

Validation of different pediatric triage systems in the emergency department

Aeimchanbanjong

Pandee

2017

World Journal of Emergency Medicine

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BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage system in the pediatric emergency department. METHODS:This was a prospective observational study. This study was divided into two phases. The fi rst phase determined the inter-rater reliability of fi ve triage systems: Manchester Triage System (MTS), Emergency Severity Index (ESI) version 4, Pediatric Canadian Triage and Acuity Scale (CTAS), Australasian Triage Scale (ATS), and Ramathibodi Triage System (RTS) by triage nurses and pediatric residents. In the second phase, to analyze the validity of each triage system, patients were categorized as two groups, i.e., high acuity patients (triage level 1, 2) and low acuity patients (triage level 3, 4, and 5). Then we compared the triage acuity with actual admission. RESULTS:In phase I, RTS illustrated almost perfect inter-rater reliability with kappa of 1.0 (P<0.01). ESI and CTAS illustrated good inter-rater reliability with kappa of 0.8-0.9 (P<0.01). Meanwhile, ATS and MTS illustrated moderate to good inter-rater reliability with kappa of 0.5-0.7 (P<0.01). In phase II, we included 1 041 participants with average age of 4.7±4.2 years, of which 55% were male and 45% were female. In addition 32% of the participants had underlying diseases, and 123 (11.8%) patients were admitted. We found that ESI illustrated the most appropriate predicting ability for admission with sensitivity of 52%, specifi city of 81%, and AUC 0.78 (95%CI 0.74-0.81).CONCLUSION: RTS illustrated almost perfect inter-rater reliability. Meanwhile, ESI and CTAS illustrated good inter-rater reliability. Finally, ESI illustrated the appropriate validity for triage system.

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Performance of the Canadian Triage and Acuity Scale for Children: A Multicenter Database Study

Cited by 75 publications

References 28 publications

Validity of Different Pediatric Early Warning Scores in the Emergency Department

Validity of Different Pediatric Early Warning Scores in the Emergency Department

Validation of the Calgary Spine Severity Score

Validation of different pediatric triage systems in the emergency department

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