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Validation of different pediatric triage systems in the emergency department

Kanokwan Aeimchanbanjong1, Uthen Pandee1

  • 1Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

World Journal of Emergency Medicine
|July 7, 2017
PubMed

Insights

The Ramathibodi Triage System (RTS) showed excellent reliability in pediatric emergency departments. The Emergency Severity Index (ESI) demonstrated the best validity for predicting patient admission, making it a suitable choice.

Area of Science:

  • Pediatric Emergency Medicine
  • Healthcare Systems Analysis
  • Clinical Triage Research

Background:

  • Pediatric triage presents unique challenges due to children's distinct physiological and psychosocial responses to stressors.
  • Determining the optimal triage system is crucial for effective pediatric emergency care.

Purpose of the Study:

  • To evaluate and compare the inter-rater reliability and validity of five distinct triage systems in a pediatric emergency setting.
  • To identify the most effective triage system for pediatric patients.

Main Methods:

  • A prospective observational study involving two phases.
  • Phase I: Assessed inter-rater reliability of five triage systems (MTS, ESI v4, CTAS, ATS, RTS) among nurses and residents.
  • Phase II: Evaluated triage system validity by comparing acuity levels with actual patient admission data for 1,041 children.

Main Results:

  • The Ramathibodi Triage System (RTS) achieved almost perfect inter-rater reliability (kappa=1.0).
  • The Emergency Severity Index (ESI) and Pediatric Canadian Triage and Acuity Scale (CTAS) demonstrated good inter-rater reliability (kappa=0.8-0.9).
  • The ESI showed the highest predictive ability for admission (sensitivity 52%, specificity 81%, AUC 0.78).

Conclusions:

  • RTS exhibits superior inter-rater reliability in pediatric triage.
  • ESI and CTAS also show good inter-rater reliability.
  • ESI demonstrates appropriate validity, making it a recommended triage system for pediatric emergency departments.
Abstract

Keywords:
Emergency departmentPediatricTriage

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