Validation of a Modified Triage Scale in a Norwegian Pediatric Emergency Department

Engan, Mette; Hirth, Asle; Trønnes, Håvard

doi:10.1155/2018/4676758

Cited by 12 publications

(18 citation statements)

References 36 publications

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“…In this study more patients received a green triage score and fewer patients received an orange triage score than the present study [15]. Using hospitalization as the sole proxy variable for true medical urgency, they report a higher sensitivity of 74% but a lower specificity of 48%, compared with our current findings on RETTS-p [15].…”

Section: Discussioncontrasting

confidence: 68%

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A validity study of the rapid emergency Triage and treatment system for children

Ødegård

Tran

Næss-Pleym

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background The Scandinavian Rapid Emergency Triage and Treatment System-pediatric (RETTS-p) is a reliable triage system that includes both assessment of vital parameters and a systematic approach to history and symptoms. In Scandinavia, the system is used in most pediatric emergency departments (PED). We aimed to study the validity of RETTS-p. Methods We conducted a study based on triage priority ratings from all children assessed in 2013 and 2014 to the PED at St. Olavs University Hospital Trondheim, Norway. Patients were assigned one of four priority ratings, based on the RETTS-p systematic evaluation of individual disease manifestations and vital parameter measurements. In the absence of a gold-standard for true disease severity, we assessed whether priority ratings were associated with 3 proxy variables: 1) hospitalization to the wards (yes vs. no), 2) length of hospital stay (≤ mean vs. > mean, and 3) referral to pediatric intensive care (yes vs. no). We further compared priority ratings with selected diagnoses and procedure codes at discharge. Results Six thousand three hundred sixty-eight children were included in the study. All analyses were performed in the entire population and separately in pediatric sub-disciplines, medicine (n = 4741) and surgery (general and neurosurgery) (n = 1306). In the entire population and the sub-disciplines, a high priority rate was significantly associated with hospitalization to wards, a longer hospital stay and referral to the pediatric intensive care unit compared to patients with low priority. We observed a dose-response relationship between increased triage code level and indicators of more severe disease (p-trend < 0.001). For the same three proxy variables, the sensitivity was 54, 61 and 83%, respectively, and the specificity 66, 62 and 57%, respectively. Subgroup analyzes within the most common complaints, demonstrated that more severe conditions were higher prioritized than less severe conditions for both medical and surgical patients. Overall, children with surgical diagnoses attained lower priority ratings than children with medical diagnoses. Conclusions RETTS-p priority ratings varies among a broad spectrum of pediatric conditions and mirror medical urgency in both medical and surgical disciplines. RETTS-p is a valid triage system for children as used in a university hospital setting.

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Section: Discussioncontrasting

confidence: 68%

“…Recently Engan and al. studied a Norwegian modified version of the South African triage scale (SATS), but this study only included children with pediatric medical complaints [15]. In this study more patients received a green triage score and fewer patients received an orange triage score than the present study [15].…”

Section: Discussionmentioning

confidence: 84%

A validity study of the rapid emergency Triage and treatment system for children

Ødegård

Tran

Næss-Pleym

et al. 2021

Scand J Trauma Resusc Emerg Med

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“…This has previously been reported as moderate sensitivity [5]. The RETTS-p specificity of 67.0% in our study was lower than that in previous MTS studies in the PED, reporting rates of 78–87% [10, 11, 17–19], but higher compared with a study from Norway, a Scandinavian country similar to Sweden with a modified paediatric SATS triage in the PED, which reported a sensitivity of 74% and a specificity of 48% [20].…”

Section: Discussioncontrasting

confidence: 82%

The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years

et al. 2019

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BackgroundThe rapid triage and treatment system for paediatrics (RETTS-p) has been used by the emergency medical services (EMS) in the west of Sweden since 2014. The performance of the RETTS-p in the pre-hospital setting and the agreement between the EMS nurse’s field assessment and the hospital diagnosis is unknown. The aim of this study was to evaluate the performance of the RETTS-p in the EMS and the agreement between the EMS field assessment and the hospital diagnosis.MethodsA prospective observational study was conducted among 454 patients < 16 years of age who were assessed and transported to the PED. Two instruments were used for comparison: 1) Classification of an emergent patient according to predefined criteria as compared to the RETTS-p and 2) Agreement between the EMS nurse’s field assessment and the hospital diagnosis.ResultsAmong all children, 11% were identified as having vital signs associated with an increased risk of death and 7% were diagnosed in hospital with a potentially life-threatening condition. Of the children triaged with RETTS-p (85.9%), 149 of 390 children (38.2%) were triaged to RETTS-p red or orange (life-threatening, potentially life-threatening), of which 40 (26.8%) children were classified as emergent. The hospitalised children were triaged with the highest frequency to level yellow (can wait; 41.5%). In children with RETTS-p red or orange, the sensitivity for a defined emergent patient was 66.7%, with a corresponding specificity of 67.0%. The EMS field assessment was in agreement with the final hospital diagnosis in 80% of the cases.ConclusionsThe RETTS-p sensitivity in this study is considered moderate. Two thirds of the children triaged to life threatening or potentially life threatening were later identified as non-emergent. Of those, one in six was discharged from the PED without any intervention. Further, one third of the children were under triaged, the majority were found in the yellow triage level (can wait). The highest proportion of hospitalised patients was found in the yellow triage level. Our result is in agreement with previous studies using other triage instruments. A computerised decision support system might help the EMS triage to increase sensitivity and specificity.

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“…The history provided by the patient and parents about the presenting complaint may provide essential information about disease severity (Farrohknia et al., 2011). Other triage systems than RETTS‐p use risk factors such as newborn age or age <2–3 months, fever and chronically ill child, instead of ESS to have a second factor for triage (Engan et al., 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Although not a triage tool (Seiger et al., 2013), PEWS is also used for prioritizing patients for physician assessment in many Norwegian PEDs. Only a few departments have implemented the Manchester Triage Scale (Mackway et al., 2014), the South African triage scale (Engan et al., 2018) or the Rapid Emergency Triage and Treatment System‐pediatric (RETTS‐p) (Henning et al., 2016) for paediatric triage. Other paediatric triage systems include the Canadian Triage and Acuity Scale (Warren et al., 2008), the Emergency Severity Index (Wuerz et al., 2000, 2001) and the Australasian Triage Scale (Australasian College for Emergency Medicine, 2002).…”

Section: Introductionmentioning

confidence: 99%

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

2020

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Aim In the paediatric emergency department (PED), it is important to correctly prioritize children for physician assessment. The pediatric early warning score (PEWS), although not a triage tool, is often used for PED triage. The scandinavian Rapid Emergency Triage and Treatment System‐pediatric (RETTS‐p) is a reliability tested triage tool. We aimed to compare PEWS and RETTS‐p in a Norwegian PED. Design A reliability study. Methods The PED nurse routinely did PEWS observations, while the principal investigator concomitantly made RETTS‐p observations. Inter‐tool agreement was calculated for the complete PEWS and RETTS‐p and for vital signs scores, disregarding the RETTS‐p emergency symptoms and signs (ESS). Results Rapid Emergency Triage and Treatment System‐pediatric assigned a higher urgency than PEWS. The inter‐tool agreement between PEWS and RETTS‐p was low (weighted kappa [95% confidence interval [CI] = 0.32 [0.24–0.40]]). Weighted kappa (95% CI) was 0.50 (0.41–0.59) for PEWS and RETTS‐p without ESS, indicating that PEWS is not equivalent to five‐level triage tools.

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Validation of a Modified Triage Scale in a Norwegian Pediatric Emergency Department

Cited by 12 publications

References 36 publications

A validity study of the rapid emergency Triage and treatment system for children

A validity study of the rapid emergency Triage and treatment system for children

The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years

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

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