Event Title

Determining Accuracy of Triage of Pediatric Patients in a Community Based Emergency Department

Location

Philadelphia, PA

Start Date

11-5-2022 1:00 PM

End Date

11-5-2022 4:00 PM

Description

Introduction: All emergency departments (ED) in the United States use a triage system to assess patients quickly and determine their severity of illness. One commonly used triage system is the Emergency Severity Index (ESI), which has triage acuity from 1-5 with 1 being most acute and 5 being least acute1. Use of the ESI in pediatric populations is challenging due to differences in children and adults’ physiology and pathology1. To accurately triage pediatric patients, nurses must understand those differences.

Objective: We are investigating the accuracy of triage of pediatrics patients in a community hospital emergency department, which sees patients of all ages but lacks nurses trained in pediatrics.

Methods: This was a descriptive study of 50 patients ages 0-17 presenting to the ED. Demographic information (age, gender, ethnicity, and weight) and triage encounter details (vital signs, history of present illness, and assigned ESI) were reviewed. Data collection was done by three reviewers with an interrater reliability of 92 percent. Reviewers determined an appropriate ESI triage level for each patient based on pediatric ESI guidelines1 to assess if the patient was under-triaged, over-triaged, or appropriately triaged.

Results: Of the 50 patients, 34 (68%) were male, with an average age of 5 years and average weight of 24 kilograms, with 22% (11) identifying as non-White. Fifteen were assigned ESI level two, 21 were level three, and 14 were level four. We found that two of six (33%) infants less than one, 10 of 24 (42%) children 1-4 years, 11 of 14 (78%) patients 5-12 years, and three of six (50%) aged 13-18 were accurately triaged. Ten of thirteen (77%) patients presenting after a fall or injury as the chief complaint were accurately triaged while only 7 of 17 (41%) presenting with fever, and 5 of 15 (33%) presenting with respiratory findings were accurately triaged.

Discussion: This study showed that accuracy of triage improved with patient age. Additionally, falls and injuries were triaged more accurately than fever or respiratory symptoms, suggesting that triage nurses felt less prepared to assess pediatric infections than pediatric trauma. Future steps include nurse education regarding pediatric ESI triage followed by reassessment of triage accuracy.

Embargo Period

5-25-2022

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COinS
 
May 11th, 1:00 PM May 11th, 4:00 PM

Determining Accuracy of Triage of Pediatric Patients in a Community Based Emergency Department

Philadelphia, PA

Introduction: All emergency departments (ED) in the United States use a triage system to assess patients quickly and determine their severity of illness. One commonly used triage system is the Emergency Severity Index (ESI), which has triage acuity from 1-5 with 1 being most acute and 5 being least acute1. Use of the ESI in pediatric populations is challenging due to differences in children and adults’ physiology and pathology1. To accurately triage pediatric patients, nurses must understand those differences.

Objective: We are investigating the accuracy of triage of pediatrics patients in a community hospital emergency department, which sees patients of all ages but lacks nurses trained in pediatrics.

Methods: This was a descriptive study of 50 patients ages 0-17 presenting to the ED. Demographic information (age, gender, ethnicity, and weight) and triage encounter details (vital signs, history of present illness, and assigned ESI) were reviewed. Data collection was done by three reviewers with an interrater reliability of 92 percent. Reviewers determined an appropriate ESI triage level for each patient based on pediatric ESI guidelines1 to assess if the patient was under-triaged, over-triaged, or appropriately triaged.

Results: Of the 50 patients, 34 (68%) were male, with an average age of 5 years and average weight of 24 kilograms, with 22% (11) identifying as non-White. Fifteen were assigned ESI level two, 21 were level three, and 14 were level four. We found that two of six (33%) infants less than one, 10 of 24 (42%) children 1-4 years, 11 of 14 (78%) patients 5-12 years, and three of six (50%) aged 13-18 were accurately triaged. Ten of thirteen (77%) patients presenting after a fall or injury as the chief complaint were accurately triaged while only 7 of 17 (41%) presenting with fever, and 5 of 15 (33%) presenting with respiratory findings were accurately triaged.

Discussion: This study showed that accuracy of triage improved with patient age. Additionally, falls and injuries were triaged more accurately than fever or respiratory symptoms, suggesting that triage nurses felt less prepared to assess pediatric infections than pediatric trauma. Future steps include nurse education regarding pediatric ESI triage followed by reassessment of triage accuracy.