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Initial assessment and triage in ER
1Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. mjshree@hotmail.com
Insights
Pediatric triage uses the Pediatric Assessment Triangle (PAT) for rapid evaluation of appearance, breathing, and circulation. This systematic approach categorizes pediatric patients by illness severity for appropriate emergency room care.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
Background:
- Emergency room triage is crucial for prioritizing patient care.
- Systematic assessment tools are needed for effective pediatric triage.
Purpose of the Study:
- To describe a systematic approach to pediatric emergency room triage.
- To introduce the Pediatric Assessment Triangle (PAT) and assessment pentagon as tools for evaluating pediatric patients.
Main Methods:
- The Pediatric Assessment Triangle (PAT) involves rapid visual and auditory assessment of appearance, breathing, and circulation.
- The assessment pentagon follows PAT for detailed evaluation of Airway, Breathing, Circulation, Neurologic abnormalities (D), and Exposure (head-to-toe).
Main Results:
- PAT categorizes patients as stable or unstable (life-threatening or non-life-threatening).
- The assessment pentagon guides further evaluation for patients needing stabilization.
- Illness severity is triaged into five acuity levels: Resuscitation, Emergent, Urgent, Less urgent, and Non-urgent care.
Conclusions:
- The PAT and assessment pentagon provide a structured framework for pediatric emergency triage.
- These systematic methods ensure efficient and accurate assessment of critically ill children, guiding appropriate care prioritization.
Abstract:
Triage refers to quick assessment of a patient in the Emergency Room with a view to define urgency of care and priorities in management. Triage evaluation can be completed in an organized and systematic manner using Pediatric Assessment Triangle (PAT), which refers to immediate visual and auditory assessment of appearance, breathing and circulation. At the end of PAT, patient's illness is categorized as either stable or unstable. Unstable conditions are further classified into life threatening and non life threatening. Patients in the former category include those in need of immediate resuscitation e.g. cardiac arrest, cardio-respiratory failure, decompensated shock, deep coma, severe stridor etc. Once a child is on the way to stabilization, the primary assessment (assessment pentagon),which takes 1-3 min follows. It involves the detailed physical examination/assessment of airway (A), breathing (B), circulation(C), neurologic abnormalities (D) and head to- toe examination (Exposure). After the primary assessment, patient's illness severity is triaged into 5 levels of acuity based on the physiological abnormalities: those in need of Resuscitation, Emergent care, Urgent care, Less urgent and Non-urgent care.
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