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

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.

Keywords: Area under the receiver operating characteristic curve; Critical ill children; Pediatric assessment triangle; Pediatric early warning score; Sensitivity; Specificity; Youden index.