Article Text

  1. T. M. Thompson,
  2. R. M. Dick,
  3. K. L. Stanford,
  4. C. J. Graham
  1. Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR


A triage system is used in most pediatric emergency departments to perform a rapid physiological assessment of each patient and to determine the order in which patients are seen. A variety of parameters may be assessed in the triage assessment. The purpose of this study was to examine current triage practices in pediatric emergency departments in the United States.

Methods A mailed survey was sent in August 2005 to the medical director of the 99 pediatric emergency departments listed on the National Association of Children's Hospitals and Related Institutions (NACHRI) Web site using addresses downloaded from the site. A second mailing was sent to nonresponders in October 2005. The cover letter assured the respondent that results would only be reported in aggregate fashion. The study protocol was reviewed and found exempt by the UAMS IRB.

Results 35 surveys were returned to date. The mean annual emergency department (ED) patient volume was 46,700. There is significant variation in the assessment of various physiological measurements at triage. For example, 100% of medical directors reported that all patients have pulse rate and respiratory rate assessed at triage, but only 86% take temperature on all patients, 51% take blood pressure on all patients, 29% assess pulse oximetry on all patients, and 11% perform a Glasgow Coma Scale on all patients. The methods used to measure temperature are quite variable; 97% use rectal for 0-2 month olds, 65% use rectal for 12-14 month olds, and 34% use rectal for 2-3 year olds. The use of tympanic thermometry varies by age: none use for 0-2 month olds, 14% for 2-12 month olds, 26% for 12-14 month olds, and 29% for 2-3 year olds. Most (89%) use an electronic method of assessing blood pressure routinely. The method used to assess pain is variable: for 0-2 years about half use a Wong faces scale and half use a behavioral scale. At 2-4 years, most (77%) use the Wong faces scale, but in older 10- to 18-year-old patients, most (74%) use a numerical scale. ED medical directors reported having standing orders at triage for antipyretic for fever (94%), urinalysis for abdominal pain (54%), pregnancy test for adolescent female with abdominal pain (46%), and pain medication for extremity trauma (47%).

Conclusions Despite the important decisions made based on triage assessment in a pediatric emergency department, there is wide variability in the parameters assessed and the methodology used. Additional research should focus on the validity and reliability of each assessment to determine the best practices.

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