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Clinical Considerations When Applying Vital Signs in Pediatric Korean Triage and Acuity Scale
Bongjin Lee1,2, Do Kyun Kim1, June Dong Park2
1Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Pediatric triage accuracy improves when nurses use clinical judgment over solely relying on initial vital signs. This approach better predicts hospitalization and intensive care unit admission rates for children.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Clinical Decision-Making
Background:
- Pediatric emergency department vital signs can be skewed by anxiety, leading to inaccurate triage.
- The Pediatric Korean Triage and Acuity Scale (PedKTAS) is a standard tool for pediatric triage.
- Current triage practices may over-assign severity based on transient vital sign abnormalities.
Purpose of the Study:
- To evaluate the effectiveness of pediatric triage based on clinical decision-making versus direct vital sign application.
- To compare the predictive accuracy of "real practice" (RP) triage levels with "simulation" (S) levels derived from vital signs.
- To determine if clinical judgment in triage correlates better with patient outcomes.
Main Methods:
- Retrospective analysis of 22,841 pediatric emergency department visits.
- Comparison of RP-PedKTAS levels (nurse's clinical judgment) with S-PedKTAS levels (direct vital sign application).
- Correlation analysis between triage levels and actual hospitalization and intensive care unit (ICU) admission rates.
Main Results:
- RP-PedKTAS levels showed a significant correlation with hospitalization rates (P = 0.002) and ICU admissions (P = 0.001, P = 0.012).
- S-PedKTAS levels did not significantly correlate with hospitalization rates (P = 0.151) or ICU admissions (P = 0.267, P = 0.188).
- Clinical decision-based triage (RP-PedKTAS) demonstrated superior predictive accuracy for patient outcomes.
Conclusions:
- Pediatric triage decisions should prioritize clinical assessment over the direct application of initial vital signs.
- Using experienced nurses' clinical judgment within the PedKTAS framework improves the prediction of patient disposition.
- This study supports refining triage protocols to incorporate comprehensive clinical evaluation for better resource allocation in pediatric emergency care.
Abstract:
Initial vital signs of children at the emergency department may be abnormal because of anxiety and irritability, resulting in unrealistic triage levels. This study aimed to evaluate the effectiveness of pediatric triage by clinical decision based on the patient's general condition. The Pediatric Korean Triage and Acuity Scale (PedKTAS) has been used nationwide for triage since 2016. The triage level, as assessed by an experienced triage nurse and based on the patient's clinical condition, was defined as the 'real practice (RP)-level,' while the re-calculated triage level, as assessed by the direct application of initial vital signs, was defined as the 'simulation (S)-level.' A total of 22,841 patients were triaged during the study period. The hospitalization rate according to RP-PedKTAS levels exhibited a significant correlation with the expected hospitalization rate suggested by the Pediatric Canadian Triage and Acuity Scale (CTAS) (P = 0.002), whereas the S-PedKTAS levels did not (P = 0.151). Compared with the previously reported pediatric CTAS level-specific hospitalization rate and intensive care unit (ICU) admission rate, RP-PedKTAS was significantly correlated with both hospitalization rate and ICU admission rate (P = 0.001 and P = 0.012, respectively). However, S-PedKTAS showed no significant correlation in both (P = 0.267 and P = 0.188, respectively). The determination of triage levels based on clinical decision rather than the direct application of abnormal initial vital signs to PedKTAS is more accurate in predicting the hospitalization rate and ICU admission rate.
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