The Validity of the Pediatric Assessment Triangle as the First Step in the Triage Process in a Pediatric Emergency Department (original) (raw)
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Reliability and Validity of the Emergency Severity Index for Pediatric Triage
Academic Emergency Medicine, 2009
Objectives: The Emergency Severity Index (ESI) triage algorithm is a five-level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all-age population, but has not been well studied for pediatric triage. This study assessed the reliability and validity of the ESI for pediatric triage at five sites.
Reliability and validity of the emergency severity index triage algorithm in a pediatric population
Annals of Emergency Medicine, 2004
Study objectives: As demand for emergency services has continued to outpace available allocated resources in recent years, emergency department (ED) triage systems have faced increasing scrutiny. Longer queues for care make the use of a reliable, valid triage system imperative to patient safety. Little is known about the reliability and validity of triage systems in children. The purpose of this study is to evaluate the reliability and validity of the Emergency Severity Index (ESI) triage algorithm in a pediatric population.Methods: This 2-phase investigation used a methodologic design. In the first phase, interrater reliability was evaluated using ED triage scenarios, as well as in a prospective cohort of ED patients presenting to triage. ED triage nurses and nurse and physician investigators performed retrospective blinded triages using only the original triage note to assess reproducibility. In phase 2, validity was assessed using a retrospective analysis of observed resource use, ED length of stay, and hospitalization compared with resource utilization estimated at triage by the ESI.Results: During the validity phase, 510 patients were included in the final data analysis. Hospitalization, ED length of stay, and resource utilization were strongly associated with ESI category. In the reliability phase, weighted κ for ED nurse triage of standard scenarios ranged from 0.84 to 1.00, representing excellent agreement. Twenty ED pediatric patients were triaged simultaneously by an ED triage nurse and the nurse investigator. Weighted κ was 0.82 (95% confidence interval 0.66 to 0.98), also representing strong agreement between raters.Conclusion: When used to triage pediatric patients, the ESI triage algorithm demonstrated both reliability and validity in this tertiary care pediatric population.
Evaluation of the Emergency Severity Index (version 3) triage algorithm in pediatric patients
Academic Emergency Medicine, 2005
Objectives: As demand for emergency services outpaces available allocated resources, emergency department (ED) triage systems face increasing scrutiny. Longer waits for care make the use of reliable, valid triage systems imperative to patient safety. Little is known about the reliability and validity of triage systems in children. The purpose of this study was to evaluate the reliability and validity of the Emergency Severity Index version 3 (ESIv.3) triage algorithm in a pediatric population. Methods: This two-phase investigation used both retrospective chart review and prospective, observational designs. Interrater reliability was evaluated using ED triage scenarios, a prospective cohort of ED patients presenting to triage, and retrospective triage assignments using the original triage note. ED triage nurses, nurse investigators, and physician investigators performed retrospective blinded triages using only the original triage note to assess reproducibility. In the second phase, validity was assessed using a retrospective analysis of observed resource use, ED length of stay, and hospital-ization compared with resource utilization estimated at triage by the ESI. Results: In the reliability phase, weighted k for ED nurse triage of standard scenarios ranged from 0.84 to 1.00, representing excellent agreement. Twenty ED pediatric patients were triaged simultaneously by an ED triage nurse and the nurse investigator. Weighted k was 0.82 (95% confidence interval = 0.66 to 0.98), also representing strong agreement between raters. When used for retrospective chart review, the weighted k statistics ranged from 0.42 to 0.84, representing poor to good agreement among the different categories of reviewers. During the validity phase, 510 patients were included in the final data analysis. Hospitalization, ED length of stay, and resource utilization were strongly associated with ESIv.3 category. Conclusions: The ESI triage algorithm demonstrated reliability and validity between triage assignment and resource use in this group of ED pediatric patients.
International Journal of Emergency Medicine, 2013
Background: The Emergency Severity Index (ESI) has earned reliability and validity in adult populations but has not been adequately evaluated in pediatric patients. The aim of this study was to assess the reliability of the ESI version 4 and inter-rater reliability measures to evaluate the performance of nurses in the emergency ward. Methods: Raters were part of the same team of pediatric emergency medicine team, including pediatric emergency medicine (PEM) physicians and pediatric triage (PT) nurses. Reliability and agreement rates were measured using kappa statistics. The measurements were compared with the admission rates, readmissions to the PEM division, location of admission and death as outcomes.
Academic Emergency Medicine, 2002
To compare triage level assignments, using simulated written case scenarios, in a pediatric emergency department (ED) among registered nurses (RNs) and pediatric emergency physicians (PEPs) and to compare the triage level assignments among RNs and PEPs with a consensus criterion standard. Methods: This was a cross-sectional mailed questionnaire survey. The study was conducted at a pediatric tertiary care center with more than 65,000 annual patient visits. Participants were PEPs and RNs working in the ED. Dillman's Total Design Method, with three mailouts, was used for questionnaire construction and implementation. The survey included 55 case scenarios of patients presenting to the ED. Participants were instructed to assign triage level on each case, using the following four-level triage scale: 1 = resuscitation/emergent, 2 = urgent, 3 = less-urgent, and 4 = non-urgent. A priori, all cases were assigned a triage level by consensus agreement of three PEPs, using estab-lished triage guidelines from the RNs' teaching manual. Kappa statistics (95% CI) and the mean percentage of correct responses (Ϯ1 SD) were calculated. Results: There was a 100% response rate (39 RNs, 24 PEPs). The kappa level of agreement (95% CI) was 0.453 (0.447 to 0.459) among the RNs and was 0.419 (0.409 to 0.429) among the PEPs. The mean percentage of correct responses (Ϯ1 SD) for the RNs was 64.2% (Ϯ8.0%) and for the PEPs was 53.5% (Ϯ8.1%, p < 0.01). There was no significant difference within groups by experience level (<10 vs. Ն10 years) or by the type of work schedule (day vs. evening vs. overnight) or full-time vs. part-time status. Conclusions: The level of agreement and accuracy of triage assignment was only moderate for both RNs and PEPs. Triage, a crucial step in emergency care, requires improved measurement.
Validation of a Modified Triage Scale in a Norwegian Pediatric Emergency Department
International Journal of Pediatrics, 2018
Objective. Triage is a tool developed to identify patients who need immediate care and those who can safely wait. The aim of this study was to assess the validity and interrater reliability of a modified version of the pediatric South African triage scale (pSATS) in a single-center tertiary pediatric emergency department in Norway. Methods. This prospective, observational study included all patients with medical conditions, referred to the pediatric emergency department of a tertiary hospital in Norway from September 1, 2015, to November 17, 2015. Their assigned triage priority was compared with rate of hospitalization and resource utilization. Validity parameters were sensitivity, specificity, positive and negative predictive value, and percentage of over-and undertriage. Interrater agreement and accuracy of the triage ratings were calculated from triage performed by nurses on written case scenarios. Results. During the study period, 1171 patients arrived at the hospital for emergency assessment. A total of 790 patients (67 %) were triaged and included in the study. The percentage of hospital admission increased with increasing level of urgency, from 30 % of the patients triaged to priority green to 81 % of those triaged to priority red. The sensitivity was 74 %, the specificity was 48 %, the positive predictive value was 52 %, and the negative predictive value was 70 % for predicting hospitalization. The level of over-and undertriage was 52 % and 26 %, respectively. Resource utilization correlated with higher triage priority. The interrater agreement had an intraclass correlation coefficient of 0.99 by Cronbach's alpha, and the accuracy was 92 %. Conclusions. The modified pSATS had a moderate sensitivity and specificity but showed good correlation with resource utilization. The nurses demonstrated excellent interrater agreement and accuracy when triaging written case scenarios.
2016
Background The Pennine Acute Trust (PAT) Paediatric Observation Priority Score (PAT-POPS) is a specific emergency department (ED) physiological and observational aggregate scoring system, with scores of 0–18. A higher score indicates greater likelihood of admission. The Manchester Children's Early Warning System (ManChEWS) assesses six physiological observations to create a trigger score, classified as Green, Amber or Red. Methods Prospectively collected data were used to calculate PAT-POPS and ManChEWS on 2068 patients aged under 16 years (mean 5.6 years, SD 4.6) presenting over 1 month to a UK District General Hospital Paediatric ED. Receiver operating characteristics (ROC) comparison, using STATA V.13, was used to investigate the ability of ManChEWS and PAT-POPS to predict admission to hospital within 72 h of presentation to the ED. Results Comparison of the area under the ROC curve indicates that the ManChEWS ROC is 0.67 (95% CI 0.64 to 0.70) and the PAT-POPS ROC is 0.72 (95...
BMC Pediatrics, 2019
Background The rapid triage and treatment system for paediatrics (RETTS-p) has been used by the emergency medical services (EMS) in the west of Sweden since 2014. The performance of the RETTS-p in the pre-hospital setting and the agreement between the EMS nurse’s field assessment and the hospital diagnosis is unknown. The aim of this study was to evaluate the performance of the RETTS-p in the EMS and the agreement between the EMS field assessment and the hospital diagnosis. Methods A prospective observational study was conducted among 454 patients < 16 years of age who were assessed and transported to the PED. Two instruments were used for comparison: 1) Classification of an emergent patient according to predefined criteria as compared to the RETTS-p and 2) Agreement between the EMS nurse’s field assessment and the hospital diagnosis. Results Among all children, 11% were identified as having vital signs associated with an increased risk of death and 7% were diagnosed in hospital ...