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High rate of missing vital signs data at triage in a paediatric emergency department
Jocelyn Gravel1, Lucie Opatrny, Serge Gouin
1Division of Emergency Medicine, Department of Paediatrics, Sainte-Justine Hospital, Montreal, Quebec. Graveljocelyn@hotmail.com
Insights
Missing vital signs data is common in pediatric emergency triage. Higher triage acuity and daytime/evening shifts increase the likelihood of incomplete vital signs documentation.
Area of Science:
- Pediatric Emergency Medicine
- Health Informatics
- Clinical Triage
Background:
- Vital signs measurement is standard in pediatric emergency department triage.
- Studies indicate a variable incidence of missing data for vital signs.
- This highlights a potential gap in routine patient assessment.
Purpose of the Study:
- To evaluate the rate of missing vital signs data during pediatric emergency triage.
- To identify clinical and environmental factors predicting missing vital signs data.
Main Methods:
- Retrospective cohort study of consecutive patients in a tertiary pediatric emergency department.
- Data collected included demographics and clinical information.
- Multivariate logistic regression analyzed determinants of missing data for temperature, heart rate, respiratory rate, blood pressure, and pulse oximetry.
Main Results:
- Triage level was an independent predictor of missing data for heart rate, respiratory rate, blood pressure, and pulse oximetry.
- Patients presenting during day and evening shifts had higher rates of missing data compared to night shifts.
- Decreased consciousness, immunocompromised state, and physician referral were not significant predictors.
Conclusions:
- A high rate of missing vital signs data was observed in pediatric emergency triage.
- Patient acuity (triage level) and presentation shift (day/evening) were independently associated with increased missing data.
- These findings suggest areas for targeted quality improvement initiatives.
Background:
Vital signs measurement is considered standard practice in paediatric emergency department triage assessment, but studies have shown variable incidence of missing data.
Objectives:
To evaluate the rate of missing data for vital signs at triage and to determine clinical and environmental predictive factors.
Methods:
A retrospective cohort design was used to study a database of consecutive patients registered at a tertiary paediatric emergency department during randomly chosen shifts. Demographic and clinical data were collected. Univariate and multivariate logistic regression analyses were performed to evaluate the determinants of missing data for body temperature, heart rate, respiratory rate, blood pressure and pulse oximetry.
Results:
There were 2081 patients triaged during the study periods. On multivariate logistic regression analysis, triage level (from 1 = priority to 4 = nonurgent) was an independent predictor of missing data for heart rate, respiratory rate, blood pressure and pulse oximetry (OR 1.48 to 2.05). Patients visiting the emergency department during the day shift (OR 1.08 to 4.72) and the evening shift (OR 1.38 to 9.24) had a higher rate of missing data than those visiting during the night shift. A decreased level of consciousness, an immunocompromised state and referral by a physician did not meet statistical significance as predictive factors.
Conclusions:
There was a high rate of missing data for vital signs. Factors related to patients' clinical characteristics, such as acuity of triage level, were associated with a higher rate of vital signs documentation at triage. An environmental factor, shift of presentation, was also independently associated with a higher rate.
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