Vital signs for children at triage: A multicentre validation of the revised South African Triage Scale (original) (raw)

Abstract

Emergency centre (EC) triage should enable rapid prioritisation of paediatric patients to determine how urgently children require care. Triage scales vary and are designed according to their unique context. [1] Most are based on a list of clinical discriminators; some include individual vital signs, while others include early warning scores (EWSs) or symptom-based algorithms. When identifying life-threatening conditions in children, individual vital signs are known to be poor predictors. [2] EWSs are known for their ability to detect physiological changes relating to vital signs. [3] Combining various standardised physiological parameters into an EWS has recently been recognised as a powerful tool in initiating appropriate responses from the initial contact at triage. [4,5] The benefits of an EWS include its objectivity and the fact that an aggregated score is a stronger predictor than individual vital signs and reliance on routinely recorded vital signs. [6] It is acknowledged that accurate triage is compromised when using EWSs without considering clinical discriminators such as purpuric rash and dehydration. [7] In South Africa (SA), the Triage Early Warning Score (TEWS)-consisting of mobility, respiratory rate, pulse, temperature, level of consciousness and presence of traumahas been introduced as part of the South African Triage Scale (SATS), a multilayered approach to risk reduction at triage. Healthcare workers follow a simple algorithm (Appendix 1, available online: http://dx.doi.org/10.7196/SAMJ.6877) and perform triage based on clinical discriminators as well as an age-appropriate composite physiological score, the TEWS. The SATS has four priority levels-emergency, very urgent, urgent and non-urgent, referred to as red, orange, yellow and green, respectively. The SATS has been used as an evidence-based triage tool in ECs across different levels of care in the Western Cape province of SA.

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