Limitations in validating emergency department triage scales
Validity indicators including sensitivity (Se), specificity, positive predictive value and negative predictive value (NPV) were used to estimate the validity.Associated percentages for over-/under-triage were used to further assess practical application of the paediatric SATS. The percentage of hospital admissions increased with an increase in the level of urgency from 5% in the non-urgent patients to 73% in the emergency patients.Their baseline demographics are presented in Table 1.The triage acuity level with the highest number of participants was the non-urgent category, representing 44.2% of the study population; the emergency category had the lowest number of participants (180 children), representing 9.9%.A total of 443 children (21.5%) were admitted and 1 450 (72.0%) were discharged.Of the children, 1 881 were included in the sensitivity analyses shown in Table 2 and Figs 2 - 4; 133 data forms were excluded, as 40 (2.1%) had no documentation of disposition, 6 (0.3%) were lacking information on the triage acuity level, 5 (0.3%) had incomplete TEWS calculations, 1 patient died, and 81 patients (4.0%) were referred and could not be followed up. Comparing sensitivity, specificity, over-triage, under-triage, and positive and negative predictive values when using clinical signs or TEWS in isolation as opposed to in combination as the SATS TEWS = Triage Early Warning Score; SATS = South African Triage Scale; Se = sensitivity; Sp = specificity; OT = over-triage; UT = under-triage; PPV = positive predictive value; NPV = negative predictive value.
1 Most are based on a list of clinical discriminators; some include individual vital signs, while others include early warning scores (EWSs) or symptom-based algorithms.
The data demonstrated that sensitivity increased substantially when using the SATS, which is a combination of clinical discriminators and the Triage Early Warning Score (TEWS) (Se 91.0%, NPV 95.3%), compared with use of clinical discriminators in isolation (Se 57.1%, NPV 86.3%) or the TEWS in isolation (Se 75.6%, NPV 89.1%).
Emergency centre (EC) triage should enable rapid prioritisation of paediatric patients to determine how urgently children require care.
those children triaged to the lowest category are genuinely non-urgent cases).
The paediatric SATS has been shown to have an Se of 91% and an NPV of 95.3%, which demonstrates that it has an excellent ability to identify seriously ill children when admission is used as a marker for urgency.
At each site one shift of nurses was trained to use the revised paediatric SATS.