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Performance of the Canadian Triage and Acuity Scale for children: a multicenter database study
Jocelyn Gravel1, Eleanor Fitzpatrick, Serge Gouin
1Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada. graveljocelyn@hotmail.com
Insights
The Canadian Triage and Acuity Scale (CTAS) effectively predicts pediatric emergency department outcomes. Higher CTAS levels correlated with increased hospitalization and ICU admission, validating its use for children.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality and Safety
- Clinical Triage Systems
Background:
- The Canadian Triage and Acuity Scale (CTAS) is widely used in emergency departments.
- Validating triage tools is crucial for ensuring appropriate patient care and resource allocation.
- Limited data exists on the real-world validity of CTAS for pediatric populations.
Purpose of the Study:
- To evaluate the association between CTAS levels and surrogate markers of validity in children.
- To assess the predictive accuracy of CTAS for pediatric emergency department outcomes.
- To determine the reliability of CTAS in a multi-center pediatric setting.
Main Methods:
- Retrospective cohort study of 550,940 children across 12 pediatric emergency departments.
- Data collected from computerized databases between 2010 and 2011.
- Primary outcome: hospitalization proportion by CTAS level. Secondary outcomes: ICU admission, left without being seen (LWBS) rate, and length of stay (LOS).
Main Results:
- Significant variations in hospitalization rates across CTAS levels (61% for Level 1 to 0.9% for Level 5).
- Strong associations observed between CTAS level and ICU admission, LWBS probability, and ED length of stay.
- Expected patient numbers per category were exceeded, ensuring robust statistical power.
Conclusions:
- The CTAS demonstrates strong validity for children in Canadian pediatric emergency departments.
- Triage level is a significant predictor of pediatric patient severity and disposition.
- Findings support the continued use and reliability of the CTAS for pediatric triage.
Study Objective:
We evaluate the association between triage levels assigned using the Canadian Triage and Acuity Scale and surrogate markers of validity for real-life children triaged in multiple emergency departments (EDs).
Methods:
This was a retrospective cohort study evaluating the triage assessment and outcomes of all children presenting to 12 pediatric EDs, all of which are members of the Pediatric Emergency Research Canada group, during a 1-year period (2010 to 2011). Anonymous data were retrieved from the ED computerized databases. The primary outcome measure was the proportion of children hospitalized for each triage level. Other outcomes were ICU admission, proportion of patients who left without being seen by a physician, and length of stay in the ED. Evaluation of all children visiting these EDs during 1 year was expected to provide more than 1,000 patients in each triage category.
Results:
A total of 550,940 children were included. Pooled data demonstrated hospitalization proportions of 61%, 30%, 10%, 2%, and 0.9% for patients in Canadian Triage and Acuity Scale levels 1, 2, 3, 4, and 5, respectively. There was a strong association between triage level and admission to the ICU, probability of leaving without being seen by a physician, and length of stay.
Conclusion:
The strong association between triage level and multiple markers of severity in 12 Canadian pediatric EDs suggests validity of the Canadian Triage and Acuity Scale for children.
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