Reliability of triage systems for paediatric emergency care: a systematic review

Abstract

ObjectiveTo present a systematic review on the reliability of triage systems for paediatric emergency care.MethodsA search of MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online, Nursing Database Index and Spanish Health Sciences Bibliographic Index for articles in English, French, Portuguese or Spanish was conducted to identify reliability studies of five-level triage systems for patients aged 0–18 years published up to April 2018. Two reviewers performed study selection, data extraction and quality assessment as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.ResultsTwenty studies on nine triage systems were selected: the National Triage System (n=1); the Australasian Triage Scale (n=3); the paediatric Canadian Triage and Acuity Scale (PedCTAS) (n=5); the Manchester Triage System (MTS) (n=1); the Emergency Severity Index (ESI) (n=5); an adaptation of the South African Triage Scale for the Princess Marina Hospital in Botswana (n=1); the Soterion Rapid Triage System (n=1); the Rapid Emergency Triage and Treatment System-paediatric version (n=2); the Paediatric Risk Classification Protocol (n=1). Ten studies were performed with actual patients, while the others used hypothetical scenarios. The studies were rated low (n=14) or moderate (n=6) quality. Kappa was the most used statistic, although many studies did not specify the weighting. PedCTAS, MTS and ESI V.4 exhibited substantial to almost perfect agreement in moderate quality studies.ConclusionsThere is some evidence on the reliability of the PedCTAS, MTS and ESI V.4, but most studies are limited to the countries where they were developed. Efforts are needed to improve the quality of the studies, and cross-cultural adaptation of those tools is recommended in countries with different professional qualification and sociocultural contexts.

Pediatric Patients in a Local Nepali Emergency Department: Presenting Complaints, Triage and Post-Discharge Mortality

“…222 49113 4433 (38) 40 49149 (42) Janajati 2546 (44) 1068 (47) 932 (42) 193 (43) 117 4644 5031 (38) 161 (46) Dalit 507 (9) 219 (10) 193 (9) 30 719 78 ( Presentation to ED, n (%)* 08:00-16:00 weekdays 1037 (24) 481 (28) 322 (19) 96 2837 2023 (38) 24 (40) 54 2216:00-08:00 or holidays 465 (27) 567 (34) 76 (22) 56 3019 3217 (28) 67 (27) ICU or OT or Referred 341 (8) 126 7117 726 826 1418 307 1221 ( Other complaints included musculoskeletal, neurology, urinary, cardiovascular diseases or complaints, psychology, and other general complaints.…”

“…The RETTS triage system was developed in Sweden and has been increasingly used in the Scandinavian countries. [17][18][19] Pediatric emergency triage system was recently systematically assessed, 38 and only one of the 18 studies of triage system reliability identified in the systematic review 38 was from a LIC. 39 Thus, the present report of triage priority categories in a pediatric population in a low income setting is unique.…”

Characteristics and outcome of patients triaged by telephone and transported by ambulance: a population‐based study in Osaka, Japan

“…In a systemic review of reliability of various triage protocols for emergency pediatric patients, studies Interhospital transfer 32 (0. 20 On the other hand, studies for various ambulance dispatch protocols revealed the validation specific conditions such as stroke, acute coronary syndrome, outof-hospital cardiac arrest, and trauma. [21][22][23][24][25][26][27] Based on these previous studies, we selected hospitalization as a measure to assess the validity of telephone triage protocol in this study.…”

“…Indicators for assessing the validity of triage protocol are controversial. In a systemic review of reliability of various triage protocols for emergency pediatric patients, studies used the agreement of triage nurses and pediatric emergency medicine physicians as an indicator of the reliability of triage protocol 20 . On the other hand, studies for various ambulance dispatch protocols revealed the validation specific conditions such as stroke, acute coronary syndrome, out‐of‐hospital cardiac arrest, and trauma 21–27 .…”

Pediatric early warning score versus a paediatric triage tool in the emergency department: A reliability study

“…Correct use of the RETTS‐p requires extensive training and experience. RETTS‐p has only been tested for reliability, not validity (Henning et al., 2016; Magalhaes‐Barbosa et al., 2019; Westergren et al., 2014).…”