Triage: a literature review 1985–19930

McDonald, Laura; Butterworth, Tony; Yates, David

doi:10.1016/0965-2302(95)90005-5

Cited by 27 publications

(10 citation statements)

References 21 publications

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“…In the past, discrepancies in triage level between nurses and physicians have been reported. 2,[5][6][7][8][9][10] These differences may be, in part, due to the time lag between the registered nurses' (RNs') and the pediatric emergency physicians' (PEPs') assessments. 11 In the interim, many children have re-ceived antipyretics, analgesics, or hydration, any of which may affect the overall appearance of the child.…”

mentioning

confidence: 99%

Comparison of Triage Assessments among Pediatric Registered Nurses and Pediatric Emergency Physicians

Bergeron

Gouin

Bailey

et al. 2002

Academic Emergency Medicine

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Objectives:To compare triage level assignments, using simulated written case scenarios, in a pediatric emergency department (ED) among registered nurses (RNs) and pediatric emergency physicians (PEPs) and to compare the triage level assignments among RNs and PEPs with a consensus criterion standard. Methods: This was a cross-sectional mailed questionnaire survey. The study was conducted at a pediatric tertiary care center with more than 65,000 annual patient visits. Participants were PEPs and RNs working in the ED. Dillman's Total Design Method, with three mailouts, was used for questionnaire construction and implementation. The survey included 55 case scenarios of patients presenting to the ED. Participants were instructed to assign triage level on each case, using the following four-level triage scale: 1 = resuscitation/emergent, 2 = urgent, 3 = less-urgent, and 4 = non-urgent. A priori, all cases were assigned a triage level by consensus agreement of three PEPs, using estab-lished triage guidelines from the RNs' teaching manual. Kappa statistics (95% CI) and the mean percentage of correct responses (Ϯ1 SD) were calculated. Results: There was a 100% response rate (39 RNs, 24 PEPs). The kappa level of agreement (95% CI) was 0.453 (0.447 to 0.459) among the RNs and was 0.419 (0.409 to 0.429) among the PEPs. The mean percentage of correct responses (Ϯ1 SD) for the RNs was 64.2% (Ϯ8.0%) and for the PEPs was 53.5% (Ϯ8.1%, p < 0.01). There was no significant difference within groups by experience level (<10 vs. Ն10 years) or by the type of work schedule (day vs. evening vs. overnight) or full-time vs. part-time status. Conclusions: The level of agreement and accuracy of triage assignment was only moderate for both RNs and PEPs. Triage, a crucial step in emergency care, requires improved measurement.

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mentioning

confidence: 99%

Comparison of Triage Assessments among Pediatric Registered Nurses and Pediatric Emergency Physicians

Bergeron

Gouin

Bailey

et al. 2002

Academic Emergency Medicine

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“…In other words, valid triage should assign priority to patients who need urgent care while identifying patients that may be able to wait safely. 1,2 Many reports have demonstrated that overcrowding has been increasing in EDs in Canada and the United States during the past decade. [3][4][5] This situation highlights the importance of a valid triage system in the ED.…”

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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“…The main goal of triage is to rapidly prioritize the sickest patients while categorizing less urgent patients who are at lower risk of deterioration and morbidity. 1,2 In 1997, the Canadian Association of Emergency Physicians (CAEP) and the National Emergency Nurses' Affiliation (NENA) adopted the 5-level Canadian ED Triage and Acuity Scale (CTAS), which has since become mandatory in most Canadian provinces. 3 In 2001, CAEP, NENA and the Canadian Paediatric Society developed, by expert consensus, a 5-level pediatric triage scale derived from the adult CTAS.…”

Section: Introductionmentioning

confidence: 99%

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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Triage: a literature review 1985–19930

Cited by 27 publications

References 21 publications

Comparison of Triage Assessments among Pediatric Registered Nurses and Pediatric Emergency Physicians

Comparison of Triage Assessments among Pediatric Registered Nurses and Pediatric Emergency Physicians

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

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

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