Canadian Paediatric Triage and Acuity Scale: assessment in a European pediatric emergency department

Fernández San Martín A, Pijoán Zubizarreta JI, Ares MI, Mintegi Raso S, Javier Benito FJ

Objectives: To assess the functionality and reliability of a computerized version of the

Canadian Paediatric Triage and Acuity Scale (PaedCTAS) in a European pediatric emergency

department.

Methods: Retrospective review of emergency cases in 2007. We collected data on the

seriousness of each emergency, mean patient stay in the department, rate of admission,

and tests ordered. The reliability of the scale was estimated by calculating the agreement

between raters’ theoretical classification of cases and the reference assessment.

Results: A total of 57617 emergencies were analyzed. The distribution by levels of

severity were as follows: level 1, 0.07%; level 2, 1.73%; level 3, 43.1%; level 4, 50%;

and level 5, 5.1%. The frequency of orders for tests ranged from 63.6% at level 1 to 8%

at level 5 (P<.01). The mean duration of stay increased progressively from 72 minutes for level 5 to 373 minutes for level 1. Admission rates also differed by severity level (from 84% at level 1 to 1.6% at level 5, P<.001). The reliability study showed that triage based on the Paediatric Assessment Triangle was exact in 93.6% of the cases; the ê index was 0.77 (95% confidence interval [CI] 0.75-0.79). The scale correctly assigned the level of severity or included only a slight discrepancy in 80.3% of the cases. The ê index was 0.47 (95% CI, 0.46-0.48). Conclusions: The PaedCTAS seems to be applicable to European pediatric emergency department use although certain features of the scale could be improved for application by our emergency department.

Ares MI, Fernández San Martín A, Javier Benito FJ, Mintegi Raso S, Pijoán Zubizarreta JI