Abnormal ranges of vital signs in children in Japanese prehospital settings

Area of Science:

• Emergency Medicine
• Paediatric Triage
• Prehospital Care

Background:

• Japan's revised Fire Service Law mandates prehospital acuity scales for prefectural governments.
• The Foundation for Ambulance Service Development (FASD) developed a reference acuity scale.
• A preliminary survey indicated 32 of 47 prefectures directly applied the FASD scale for paediatric patients.

Purpose of the Study:

• To evaluate the validity of the abnormal heart rate and respiratory rate ranges on the FASD scale for paediatric patients.
• To assess the overall performance of the FASD scale in paediatric triage.
• To identify areas for improvement in the FASD scale's abnormal ranges.

Main Methods:

• Compared published centile charts for vital signs with records of 1,296 ambulance patients.
• Evaluated the validity of the FASD scale's abnormal ranges against established paediatric vital sign data.
• Assessed the scale's classification accuracy, sensitivity, and specificity for high-urgency triage.

Main Results:

• A significant overlap was observed between the FASD scale's abnormal ranges and normal centile charts for paediatric vital signs.
• The FASD scale accurately classified only 22% of paediatric patients.
• The scale demonstrated high sensitivity (91%) but low specificity (18%) for identifying high-urgency cases.

Conclusions:

• The abnormal vital sign ranges on the FASD scale require refinement for improved paediatric triage accuracy.
• The current FASD scale demonstrates limitations in effectively classifying paediatric emergency severity.
• Further research and adjustments to the FASD scale are necessary to enhance its utility in prehospital paediatric care.