The accuracy of the pediatric assessment triangle in assessing triage of critically ill patients in emergency pediatric department

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Highlights

  • PAT can be used as an assessment tool for rapid screening of the severity of children in the ED in China.

  • The PAT score is ≥ 1 point, the child can be predicted to be critically ill and give priority to treatment.

Abstract

Background

The Pediatric Assessment Triangle (PAT) is a rapid evaluation tool that establishes a child’s clinical status and his or her category of illness in order to direct initial management priorities. However, only few studies have examined its accuracy in assessing triage of critically ill patients in the emergency pediatric department (EPD) in China.

Objective

To quantitatively validate the accuracy in assessing critically ill medical children and nurses’ acceptance of PAT in the EPD.

Methods

This is a prospective observational study performed at The First People’s Hospital of Kunshan from January to May 2019. Ill children arriving to the EPD were assessed by trained nurses with the PAT and Pediatric early warning score (PEWS) at the same time. The five-level triage system used as the gold standard for comparing the accuracy of PAT was tracked following the triage. PEWS was compared with PAT in terms of assessment time and the degree of nurse’ acceptance.

Results

A total of 1608 subjects were included in this study, of whom 74 were critically ill. The AUROCC to screen out the critical children evaluated by PAT was 0.963. When the cut-off value of PAT score was 1, its sensitivity, specificity, PPV and NPV were 93.24%, 99.15%, 84.15% and 99.67%, respectively. The maximum value of the YI of PAT scored with 1 was 0.924. For the different categories of diseases, PAT had a better performance in assessing non-respiratory critical diseases (vs. respiratory critical diseases), with values of AUROCC of 0.986 vs 0.930, YI of 0.969 vs 0.858, respectively. For the different age of sick children, PAT had a better performance in assessing critical diseases in children aged 1 to 36 months (vs. 3 to 14 years), with values of AUROCC of 0.978 and 0.899, YI of 0.952 and 0.797, respectively. The assessment time of PAT was 13.81 ± 6.41 s, while PEWS score was 37.24 ± 10.29 s (t = 17.27, p < 0.001). The VAS scores of nurses’ acceptance of PAT and PEWS were 9.27 ± 0.87 and 8.57 ± 1.52, respectively.

Conclusions

PAT can be used as a rapid and effective assessment tool in emergency triage in China. When a child's PAT score is 1 or more, the child's condition is critical and priority treatment should be arranged.

Section snippets

Background

The number of newborn babies in China is increasing, and it is estimated that it will reach 1 to 2 million every year [1]. A survey on the development status of pediatrics in the tertiary grade A hospital in Guangzhou showed that the number of emergency pediatrics from 2012 to 2016 is on the rise, and the number of hospital visits has significantly increased, much faster than an increase in pediatric medical staff [2]. We investigated the visits to the emergency department of Kunshan First

Study design and setting

This was a prospective observational study in which we analyzed a cohort of children attending the EPD of a tertiary general hospital in China during a period of 5 months (January to May 2019). The study was approved by the ethics committee of The First People’s Hospital of Kunshan (No.2018-08-L002). Considering the urgency of the child’s condition and the innocuous nature of the PAT assessment of the condition, the informed consent form was signed after triage. After critical group entered the

Result

A total of 1636 children attended the EPD during the study period. Twenty-eight (1.7%) patients were excluded for refusing to participate in the study. The final analysis was based on 1608 patients’ data. There were 897 (55.78%) male, 844(52.49%) children aged 1 to 36 months, and 1319 (82.03%) children with respiratory diseases. Age range was 1 month to 14 years. Baseline characteristics are summarized in Table 1.

There were 74 critically ill children in total and 1534 non-critically ill

Discussion

Among the 1608 subjects recruited in this study, the male to female ratio was 1.26:1, which is consistent with the ratio (1.168:1) of the sixth census in China in 2010 [30]. The top five diseases in emergency pediatrics were respiratory diseases (82.03%), digestive diseases (10.57%), neurological diseases (3.61%), infectious diseases (2.80%), and accidental injuries of children (0.68%). Respiratory diseases were mainly airway infection and bronchial pneumonia; digestive diseases were mainly

Limitations

There were some limitations in this study. Firstly, only the ill children visiting emergency pediatric medical were included in this study, and the next step we will explore the effectiveness of PAT in emergency pediatric surgery children and children with diseases other than respiratory system. Secondly, the nurses’ acceptance in this study was investigated only in the outpatient and emergency room of the studied hospital. Whether it is applicable to other hospitals requires further clinical

Conclusion

  • (1)

    PAT can be used as an assessment tool for rapid screening of the severity of children in the emergency department in China;

  • (2)

    When the PAT score is more than or equal to 1 point, the child can be predicted to be critically ill and give priority to treatment;

  • (3)

    PAT is easily accepted by triage nurses in the emergency room, so this tool can be used as a quick and effective disease assessment tool in emergency pediatrics.

CRediT authorship contribution statement

Xiaomin Ma: Conceptualization, Data curation, Formal analysis. Yuanyuan Liu: Formal analysis, Writing - original draft. Mingqing Du: Investigation. Omorogieva Ojo: Writing - review & editing. Lijuan Huang: Investigation. Xiaohua Feng: Investigation. Qiong Gao: Investigation. Xiaohua Wang: Supervision, Writing - review & editing.

References (34)

  • A. Monaghan

    Detecting and managing deterioration in children

    Paediatric Nurs

    (2005)
  • C. Yan

    Pediatric Nursing

    (2017)
  • C. Li et al.

    Evaluate the effect of PAT and vital signs monitoring combined utilization in children with pneumonia

    Med Forum

    (2020)
  • Y. Zhou et al.

    Descriptive systematic evaluation of neonatal vital signs over 34 weeks of gestation

    Today Nurse.

    (2019)
  • W. Weikai et al.

    Correlation between blood lactic acidosis levels and PCIS score in PICU patients with sepsis

    J Clin Emerge

    (2015)
  • Z. Lidan et al.

    Predictive value of four pediatric scores of critical illness and mortality on evaluating mortality risk in pediatric critical patients

    Chin Crit Care Med

    (2018)
  • N. Seiger et al.

    Validity of different pediatric early warning scores in the emergency department

    Pediatrics

    (2013)
  • Cited by (0)

    1

    Xiaomin Ma and Yuanyuan Liu are co-first authors.

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