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

Magalhães‐Barbosa, Maria Clara de; Robaina, Jaqueline Rodrigues; Prata‐Barbosa, Arnaldo; Lopes, Cláudia de Souza

doi:10.1136/emermed-2016-206058

Cited by 48 publications

(73 citation statements)

References 44 publications

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“…The significant association between the procedures performed and the risk classification confirms the quality of the clinical evaluation with the use of the Guide by the nurses in the study. This fact was also observed in a systematic review, which presented studies confirming the validity and quality of screening systems for pediatric emergency patients, evidenced by the consistent association between hospitalization and resource utilization variables (18) .…”

Section: Discussionsupporting

confidence: 60%

Classificação de risco em pediatria realizada por enfermeiros com enfoque nas condições clínicas

et al. 2019

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Objective: to verify the association between the classification of risk made by the nurses and the clinical conditions presented by children and adolescents. Methods: a cross -sectional study was carried out with 397 children/adolescents in the emergency room of a public secondary hospital. In the data collection, a formulary was used, containing sociodemographic and clinical data; and the Guideline for Acceptance with Risk Rating in Pediatrics. Results: there was no significant association between the socio-demographic characteristics of the children and risk classification. They were female, aged between one and five years and weight appropriate for the age group. There was a significant association (p<0.005) between risk ratings, risk discriminators (p=0.001), procedures performed (p<0.001) and patient's destination (p=0.013). Conclusion: the association between adopted risk classification and pediatric clinical variables confirms the degree of complexity presented by children/adolescents, favoring assertive clinical evaluation by the host nurse. Descriptors: Triage; Pediatric Nursing; User Embracement; Health Promotion.Objetivo: verificar associação entre a classificação de risco realizada por enfermeiros e as condições clínicas apresentadas por crianças e adolescentes. Métodos: estudo transversal, realizado com 397 crianças/ adolescentes na emergência de hospital público de nível secundário. Utilizaram-se, na coleta de dados, de formulário, contendo dados sociodemográficos e clínicos; e do Guia de Acolhimento com Classificação de Risco em Pediatria validado. Resultados: não houve associação significativa entre características sociodemográficas das crianças e classificação de risco. Predominaram crianças do sexo feminino, idade entre um e cinco anos e peso adequado para faixa etária. Houve associação significativa (p<0,005) entre classificações de risco adotadas, discriminadores de risco (p=0,001), procedimentos realizados (p<0,001) e destino do paciente (p=0,013). Conclusão: a associação entre classificação de risco adotada e variáveis clínicas pediátricas confirma o grau de complexidade apresentado por crianças/adolescentes, favorecendo avaliação clínica assertiva por enfermeiros no acolhimento.

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Section: Discussionsupporting

confidence: 60%

Classificação de risco em pediatria realizada por enfermeiros com enfoque nas condições clínicas

et al. 2019

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“…In recognition of the need for tailored triage processes for paediatric patients, elements of the World Health Organization paediatric triage model were incorporated for the paediatric SITS algorithm. A mid upper arm circumference (MUAC) measurement was also included as a malnutrition screening tool.…”

Section: Methodsmentioning

confidence: 99%

Effective triage in the Pacific region: The development and implementation of the Solomon Islands Triage Scale

Wanefalea

Mitchell

Sale³

et al. 2019

Emerg Medicine Australasia

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Objective The ED at the National Referral Hospital in Honiara, Solomon Islands, receives approximately 50 000 patients per year. A 2014 review of ED functioning identified deficiencies in triage processes. Placement of Australian volunteer advisors provided an opportunity to develop and implement a purpose‐designed triage system. Methods Action research methodology and the ‘plan, act, observe, reflect’ cycle was employed, leading to the development of a three‐tier triage system based on the South African Triage Scale. ED patient flow and data management processes were simultaneously updated, and staff were trained in the new system. After a pilot period, the Solomon Islands Triage Scale was implemented in August 2017. Evaluation after 3 months of operation included predictive validity (using admission and case fatality rates as surrogate markers of urgency) and reliability (based on inter‐rater agreement at retrospective chart review by an independent nurse). Results In the period 1 August to 31 October, there were 10 905 presentations, of which 97.1% were allocated a triage category (1% category 1, 21.3% category 2 and the remainder category 3). Admission rates correlated closely with triage category (P < 0.01). The case fatality rate was 22.1% for category 1 patients, 0.09% for category 2 and 0.01% for category 3 (P < 0.01). An audit of 96 records conducted in October 2017 revealed 88.4% agreement for triage category allocation. Conclusion Solomon Islands Triage Scale is the first three‐tier triage scale to be implemented in the Pacific region and appears to have adequate validity and reliability. The partnership between Australian volunteers and local clinicians is a positive example of capacity development and represents a model that could be implemented in other resource‐limited settings.

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“…Because of size limitations, we split the resultant material into two groups: studies with reliability assessment to be included in the present review, and studies with validity assessment, which was already published 14. For this review on reliability, we included inter-rater and intrarater agreement studies, using clinical scenarios or actual patients, with any estimates of agreement such as kappa, intraclass correlation coefficient (ICC) or percentage of absolute concordance.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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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.

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

Cited by 48 publications

References 44 publications

Classificação de risco em pediatria realizada por enfermeiros com enfoque nas condições clínicas

Classificação de risco em pediatria realizada por enfermeiros com enfoque nas condições clínicas

Effective triage in the Pacific region: The development and implementation of the Solomon Islands Triage Scale

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

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