Is the Singapore Paediatric Triage Scale useful in emergency settings?
Use of the Singapore Paediatric Triage Scale (SPTS) in the paediatric emergency setting demonstrates strong performance in vital patient outcomes, including hospital admission, intensive care unit (ICU) admissions and length of emergency department (ED) stay, a recent study has shown.
“Overall, our results demonstrate that the SPTS used in our institution is strongly associated with the need for hospitalization and admission to the cardiac ICU, and also predicts discharge from the ED,” researchers said.
Of the 172,933 ED attendances, 2.3 percent had acuity level 1, 26.4 percent had acuity level 2 plus, 13.5 percent had acuity level 2 and 57.8 percent had acuity level 3. [Singapore Med J 2018;59:205-209]
Triage acuity level 1 had a strong positive predictive value of 79.5 percent for all admission and accounted for 85.8 percent of all initial ICU admissions, while the lowest acuity level of 3 had a strong negative predictive value of 93.7 percent and accounted for only 0.008 percent of ICU admissions.
In addition, significantly more patients with triage acuity level 1 (79.5 percent) were admitted as compared to those with triage acuity level 3 (6.3 percent; p<0.001). An association was observed between triage level and length of ED stay.
“The aim of triage is to identify patients who need to be seen urgently, and our results supported the fact that critically ill paediatric patients were identified accurately at the initial presentation, where 97.5 percent of initial ICU admissions and 92.7 percent of all eventual ICU admissions were from Category 1 and Category 2 plus according to our triage system,” researchers said.
“This suggests that the triage system is safe in terms of the primary outcome of admissions (overall and ICU),” they added.
These findings are consistent with those of a multicentre database study conducted in 12 Canadian paediatric EDs, wherein 79 percent of patients who were triaged as resuscitation or emergent were admitted to the ICU and 0.9 percent of nonurgent cases were hospitalized, of which less than 0.01 percent were admitted to the ICU. [Ann Emerg Med 2013;61:27-32.e3]
Similar strong associations between triage levels and surrogate markers of clinical severity in children have been shown by other triage tools. For example, Baumann and Strout found that triage levels assigned using the Emergency Severity Index were strongly associated with hospital admission rate, length of ED stay and resources used. [Acad Emerg Med 2005;12:219-224]
Likewise, Roukema and colleagues reported that the sensitivity and the specificity of the Manchester Triage System to identify true emergencies were 63 percent and 78 percent, respectively. [CJEM 2009;11:23-28; Am J Public Health 1980;70:804-807]
“It is important that a triage scale is able to effectively detect the ill child from the well child. This will reduce the chance of prolonged waiting for a wrongly triaged child and delayed treatment for an emergency case. Systems that have a low predictor of admission or discharge and a large proportion of under-triage are unsafe,” researchers said.
The performance markers of the SPTS to identify children who needed immediate and greater care were analysed in this retrospective observational study. Participants included all children triaged and attended to at the paediatric ED at KK Women’s and Children’s Hospital in Singapore from 1 January 2014 to 31 December 2014. Data was retrieved from the Online Paediatric Emergency Care system, which is used for patients’ care from initial triaging to final disposition.
“The validity of the SPTS would need to be further evaluated in multiple settings and populations to increase its validity and generalizability,” researchers said.