J Korean Med Sci.  2017 Oct;32(10):1702-1707. 10.3346/jkms.2017.32.10.1702.

Clinical Considerations When Applying Vital Signs in Pediatric Korean Triage and Acuity Scale

• Lee B
• Kim DK
• Park JD
• Kwak YH

• KMID: 2400445
• DOI: http://doi.org/10.3346/jkms.2017.32.10.1702

Abstract

Initial vital signs of children at the emergency department may be abnormal because of anxiety and irritability, resulting in unrealistic triage levels. This study aimed to evaluate the effectiveness of pediatric triage by clinical decision based on the patient's general condition. The Pediatric Korean Triage and Acuity Scale (PedKTAS) has been used nationwide for triage since 2016. The triage level, as assessed by an experienced triage nurse and based on the patient's clinical condition, was defined as the "˜real practice (RP)-level,' while the re-calculated triage level, as assessed by the direct application of initial vital signs, was defined as the "˜simulation (S)-level.' A total of 22,841 patients were triaged during the study period. The hospitalization rate according to RP-PedKTAS levels exhibited a significant correlation with the expected hospitalization rate suggested by the Pediatric Canadian Triage and Acuity Scale (CTAS) (P = 0.002), whereas the S-PedKTAS levels did not (P = 0.151). Compared with the previously reported pediatric CTAS level-specific hospitalization rate and intensive care unit (ICU) admission rate, RP-PedKTAS was significantly correlated with both hospitalization rate and ICU admission rate (P = 0.001 and P = 0.012, respectively). However, S-PedKTAS showed no significant correlation in both (P = 0.267 and P = 0.188, respectively). The determination of triage levels based on clinical decision rather than the direct application of abnormal initial vital signs to PedKTAS is more accurate in predicting the hospitalization rate and ICU admission rate.

Keyword

Children; Emergency Department; Triage; Pediatric Korean Triage and Acuity Scale

MeSH Terms

Anxiety
Child
Emergency Service, Hospital
Hospitalization
Humans
Intensive Care Units
Triage*
Vital Signs*

Figure

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  Fig. 1 A flow chart of the entire patient and subject distribution based on PedKTAS classification methods. PedKTAS = Pediatric Korean Triage and Acuity Scale, RP = real practice, S = simulation.

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  Fig. 2 Hospitalization rates and ICU admission rates according to triage levels. (A) Comparison of hospitalization rates according to triage levels. Gray boxes indicate the range of PedCTAS level-specific expected hospitalization rates, and black rectangles represent the median for each level. (B) ICU admission rate according to triage levels. ICU = intensive care unit, PedCTAS = Pediatric Canadian Triage and Acuity Scale, PedKTAS = Pediatric Korean Triage and Acuity Scale, RP = real practice, S = simulation. *Data from Gravel et al. (10); †Data from Gravel et al. (9).

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