Triage of Children Clinical Trial
Official title:
Triage of Children at the Emergency Department: Manchester Triage System or Pediatric Early Warning Score?
Currently, the Manchester Triage System (MTS) is used to triage all children presenting at
the emergency department(ED) in this hospital. This system has been proven safe, but many
patients are classified as too urgent. In this hospital adults are prioritised at the ED by
a score based on vital signs, the early warning score. A similar score is developed suitable
for children. This score, the Pediatric Early Warning Score (PEWS), is already used to
determine clinical deterioration.
The investigators hypothesize that children can be triaged safely with the PEWS.
If it is safe, there will be one triage system again at the ED. Another advantage will be
more continuity in assessing the condition of patients who are admitted to the hospital.
Background: Triage systems are used at EDs to prioritize patients to make sure that those
who need it, receive immediate care.
The MTS is used for children at EDs by many hospitals worldwide, also at the ED of the
Isala, the Netherlands. This triage system has been proven safe, but many patients are
classified as too urgent. This is a disadvantage because accurate triage is needed to
provide access for immediate ill patients and for sufficient flow at the ED.
Currently, adult patients at the ED of the Isala are classified by the early warning score.
This is a score based on vital signs and it is easily calculated. It originally has been
developed to determine clinical deterioration. For children normal values are different for
each age. Therefore there has been developed the PEWS, which is now only used to evaluate
clinical patients. Ideally for the continuity in this hospital, there would be one system
which can be used for triage as well as for clinical patients. The investigators hypothesize
that the PEWS is a safe alternative for the triage of children at the ED.
Design: A form will be attached on the file of all children presenting at the ED, for
recording data. These forms will be collected afterwards. The emergency department nurses
will record the vital signs, which the investigators need to calculate the PEWS as well as
the urgency determined by the MTS for each patient. The expert opinion will also be
recorded. This is de urgency according to the doctor who has seen the patient, maximal
acceptable door-to-doctor time: very urgent (immediate), urgent (<15minutes) or normal
(<1hour). At the end of the consultation at the ED, the reference standard will be
determined for each patient independent of MTS urgency or PEWS, with data available from the
patient file. (1) For secondary outcome measures may or may not hospital admission or
intensive care admission will be recorded.
No interventions are made and this study is of no influence on the treatment of the
patients.
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Time Perspective: Prospective