Canadian triage system shows validity in pediatric population
medwireNews: The Canadian Triage and Acuity Scale is a suitable tool to use in pediatric populations, indicate the results of a multicenter study involving over 550,000 children over a 1-year period.
The study shows strong associations between the scale and surrogate markers of validity such as the number of patients admitted to hospital, the number admitted to the intensive care unit (ICU), and the proportion of patients who left the emergency department (ED) without being seen.
While these markers only indicate the urgency of a situation rather than specific outcomes and are therefore not perfect criteria standards for triage, the study "has many implications for the management of children visiting the ED," suggest Jocelyn Gravel (CHU Sainte-Justine, Montreal, Quebec, Canada) and colleagues in the Annals of Emergency Medicine.
During the study period, 550,940 patients aged under 18 years visited the 12 participating EDs, with level 4 (of 5) being the most common triage level assigned, at 44.0%. Level 1 (the most severe, requiring resuscitation) had the lowest number of patients, at 0.6%.
Overall, 61.0%, 30.0%, 10.0%, 2.0%, and 0.9% of patients triaged at triage levels of 1, 2, 3, 4, and 5 were hospitalized, respectively, report the researchers, adding that for each hospital, there was a good association between triage level and the probability of admission.
There was also a strong positive association between triage level and admission to the ICU, with 79% of patients at level 1 or 2 admitted. The probability of ICU admission among triage level 4 or 5 patients was 1 in 8141 visits, with a total of 31 patients at these levels admitted.
The probability of leaving the ED without being seen was also associated with triage level, with greater patient numbers in levels 3, 4, and 5, at mean proportions of 2.4%, 6.5%, and 9.1% compared with levels 1, and 2, at mean proportions of 0 and 0.3%.
In an accompanying editorial, Charissa Pacella and Donald Yealy from the University of Pittsburg, USA, comment that using surrogate markers of ultimate care intensity leaves "a critical unanswered question: Does this triage scale improve patient care?"
They believe Gravel and team's study takes "closer steps to meaningful endpoints" but does not predict how one scale versus another can produce better outcomes.
"With the wealth of data at our disposal, we hope to see future demonstrations that implementation of a particular triage scale improves patient outcomes such as survival, functioning, or return to daily activities," they conclude.
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By Sarah Guy, medwireNews Reporter