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Aspects of triage for infants: a narrative review
Anouk Hopman1, Elise S Talsma2, Dennis O Mook-Kanamori3
1Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. a.hopman@lumc.nl.
Insights
Current infant triage systems are often inaccurate, leading to undertriage or overtriage. Integrating vital signs like heart rate and oxygen saturation with clinical features shows promise for improving infant illness severity assessment.
Area of Science:
- Pediatrics
- Emergency Medicine
- Healthcare Systems
Background:
- Infants under one year frequently present with acute illnesses to general practitioners.
- Assessing illness severity in infants is challenging due to overlapping signs and symptoms in healthy and sick infants.
- Existing triage systems, designed for older populations and validated in emergency departments, often lead to undertriage or overtriage in infants.
Purpose of the Study:
- To review existing triage and scoring systems for infants.
- To discuss the strengths and limitations of current infant triage systems.
- To explore methods for improving the accuracy of infant triage in primary care settings.
Main Methods:
- Literature review of current infant triage and scoring systems.
- Analysis of the strengths and limitations of existing systems.
- Exploration of integrating clinical features with vital signs for improved triage accuracy.
Main Results:
- Existing triage systems demonstrate limitations when applied to infants, often resulting in undertriage or overtriage.
- The BabyCheck system shows promise for infants under six months in primary care.
- Pulse oximetry offers potential improvements in infant triage accuracy.
Conclusions:
- Further research is needed to develop and validate an optimal triage system for infants under one year in general practice.
- Integrating clinical features with vital signs like heart rate and oxygen saturation may enhance triage accuracy.
- The BabyCheck system and pulse oximetry represent promising advancements for infant triage.
Abstract:
Infants under 1 year old frequently visit the general practitioner with acute illnesses. Assessing the severity of illness in this group can be challenging as signs and symptoms may be observed in both sick and healthy infants. Current triage systems are primarily designed for older children and adults and have been validated mainly in high-prevalence settings, such as emergency departments. As a result, these systems often result in undertriage, which can lead to delayed treatment and adverse outcomes.
Conclusion:
This review reports the existing triage and scoring systems, currently used in infants. We discuss the strengths and limitations of this systems. Furthermore, we explore how the integration of clinical features with vital signs, such as heart rate and oxygen saturation, can improve the accuracy of triage for infants. The BabyCheck, validated for use in primary care for infants under 6 months of age, and the use of pulse oximetry offer promising improvements. Further research is essential to develop and validate an optimal triage system for infants under one year of age in the general practitioner setting.
What Is Known:
• Current triage systems are widely used in emergency departments but show limitations, especially when applied to infants. • These existing triage systems often result in undertriage or overtriage, which can lead to either unnecessary healthcare utilization or delayed treatment for serious conditions.
What Is New:
• Combining vital signs such as heart rate and oxygen saturation with clinical features, may improve the accuracy of triage systems for infants.
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