Related Experiment Video
Updated: May 22, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Pediatric surgery triage: problems and improvements
Etsuji Ukiyama1, Yuji Nirasawa, Yoshiko Watanabe
1Department of Pediatric Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan. uki@ks.kyorin-u.ac.jp
Insights
The Canadian Paediatric Triage and Acuity Scale (P-CTAS) generally works for pediatric surgery patients but requires modifications. Improvements include age-specific categories for trauma and foreign body aspiration, and refined criteria for intussusception and acute scrotum.
Area of Science:
- Pediatric Surgery
- Emergency Medicine
- Triage Systems
Background:
- The Canadian Paediatric Triage and Acuity Scale (P-CTAS) is a standard emergency department triage tool for children.
- Pediatric surgery patients, though few, require accurate emergency or urgent triage due to potential surgical needs.
- This study investigated P-CTAS performance and identified areas for improvement in triaging pediatric surgery patients.
Purpose of the Study:
- To evaluate the effectiveness of the P-CTAS in triaging pediatric surgery patients.
- To identify specific challenges and propose modifications to the P-CTAS for this patient group.
Main Methods:
- A retrospective analysis of pediatric patients (<16 years) at Kyorin University Hospital over a four-year period.
- Patients were categorized into emergency (Group A) and non-emergency (Group B) treatment groups to assess P-CTAS triage accuracy.
- Efficiency of P-CTAS was evaluated by comparing triage levels between the two groups.
Main Results:
- Most emergency patients (97%) were assigned triage levels I-III, while 60% of non-emergency patients received level IV or higher.
- Identified needs for age-specific categories for trauma and foreign body aspiration in young children.
- Suggested specific triage criteria for intussusception (Level II) and acute scrotum (Level II with specific signs/timeframes).
Conclusions:
- The P-CTAS is a functional triage tool for pediatric surgery patients.
- Modifications, including age stratification and condition-specific criteria, are recommended to enhance P-CTAS accuracy for pediatric surgical emergencies.
Background:
The Canadian Paediatric Triage and Acuity Scale (P-CTAS) is used and modified at hospitals as a triage tool for pediatric patients before they are seen in emergency rooms. Pediatric surgery patients account for very few of the many patients in emergency departments, but they should be triaged as emergency or urgent because they might be candidates for surgery. Problems with and improvements for triaging pediatric surgery patients using the P-CTAS were studied.
Methods:
This retrospective study evaluated all patients <16 years old who visited the emergency department of Kyorin University Hospital during an approximately 4 year period between 1 May 2005, and 11 February 2009. Pediatric surgery patients were divided into two groups to evaluate the efficiency of P-CTAS triage. Patients who needed emergency treatment were in group A, and the others were in group B.
Results:
Most group A patients were level I, II, or III (97%, 111/114). In contrast, 60% (71/119) of group B patients were level IV or greater. Some problems with and suggestions for the P-CTAS were identified. Many patients with trauma were under 1 year of age, and many with a foreign body were under 2 years of age. Age categories should be added for patients with trauma or foreign body aspiration. Patients with abdominal pain, and without anal bleeding or vomiting who are >2 years old are triaged as level IV and they accounted for 12% of patients with possible intussusception in this study. A category of 'possible intussusception' should be made for level II. Most patients with acute scrotum, whether operated on or not, were level III. 'Red or purple color of scrotal skin' and/or 'within 6 h from onset' could be added to level II for patients with acute scrotum.
Conclusions:
P-CTAS worked well for pediatric surgery patients, and it needs to be modified and improved for such patients based on these results.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Kidney Transplant II: Surgical Procedure
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management