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

Emergency pediatric patients and use of the pediatric assessment triangle tool (PAT): a scoping review

BACKGROUND

We conducted a scoping review of the evidence for the use of the Pediatric Assessment Triangle (PAT) tool in emergency pediatric patients, in hospital and prehospital settings. We focused on the psychometric properties of the PAT, the reported impact, the setting and circumstances for tool implementation in clinical practice, and the evidence on teaching the PAT.

METHODS

We followed the Joanna Briggs Institute methodology for scoping reviews and registered the review protocol. We searched MEDLINE, PubMed Central, the Cochrane Library, Epistemonikos, Scopus, CINAHL, Grey literature report, Lens.org, and the web pages of selected emergency pediatrics organizations in August 2022. Two reviewers independently screened and extracted data from eligible articles.

RESULTS

Fifty-five publications were included. The evidence suggests that the PAT is a valid tool for prioritizing emergency pediatric patients, guiding the selection of interventions to be undertaken, and determining the level of care needed for the patient in both hospital and prehospital settings. The PAT is reported to be fast, practical, and useful potentially impacting overcrowded and understaff emergency services. Results highlighted the importance of instruction prior using the tool. The PAT is included in several curricula and textbooks about emergency pediatric care.

CONCLUSIONS

This scoping review suggests there is a growing volume of evidence on the use of the PAT to assess pediatric emergency patients, some of which might be amenable to a systematic review. Our review identified research gaps that may guide the planning of future research projects. Further research is warranted on the psychometric properties of the PAT to provide evidence on the tool's quality and usefulness. The simplicity and accuracy of the tool should be considered in addressing the current healthcare shortages and overcrowding in emergency services.

REVIEW REGISTRATION

Open Science Framework; 2022. https://osf.io/vkd5h/.

Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study

Early recognition of children at risk of serious illness is essential in preventing morbidity and mortality, particularly in low- and middle-income countries (LMICs). This study aimed to validate the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in acute care settings in LMICs. This observational study is based on previously collected clinical data from consecutive children attending four diverse settings in LMICs. Inclusion criteria and study periods (2010-2021) varied. We simulated the ED-PEWS, consisting of patient age, consciousness, work of breathing, respiratory rate, oxygen saturation, heart rate, and capillary refill time, based on the first available parameters. Discrimination was assessed by the area under the curve (AUC), sensitivity and specificity (previously defined cut-offs < 6 and ≥ 15). The outcome measure was for each setting a composite marker of high urgency. 41,917 visits from Gambia rural, 501 visits from Gambia urban, 2,608 visits from Suriname, and 1,682 visits from Tanzania were included. The proportion of high urgency was variable (range 4.6% to 24.9%). Performance ranged from AUC 0.80 (95%CI 0.70-0.89) in Gambia urban to 0.62 (95%CI 0.55-0.67) in Tanzania. The low-urgency cut-off showed a high sensitivity in all settings ranging from 0.83 (95%CI 0.81-0.84) to 1.00 (95%CI 0.97-1.00). The high-urgency cut-off showed a specificity ranging from 0.71 (95%CI 0.66-0.75) to 0.97 (95%CI 0.97-0.97). The ED-PEWS has a moderate to good performance for the recognition of high urgency children in these LMIC settings. The performance appears to have potential in improving the identification of high urgency children in LMICs.

Emergency Department Pediatric Readiness: A Trauma Center Quality Improvement Initiative

BACKGROUND

Most pediatric patients present to general emergency departments, yet maintaining pediatric equipment, skilled staff, and resources remains a challenge for many hospitals. Pediatric readiness assessment is now a requirement for trauma center verification.

OBJECTIVE

This study aims to assess the impact of a quality improvement initiative to improve emergency department pediatric readiness.

METHODS

A pre- and poststudy design was used to evaluate a quality improvement initiative to improve the National Pediatric Readiness assessment survey results conducted at a Southwestern United States adult Level I trauma center from September 2022 to April 2023. The multicomponent initiative included implementing a pediatric emergency care coordinator, pediatric-specific policies and procedures, identifying pediatric-specific quality and performance indicators, and educating pediatric-specific staff. Study inclusion criteria were all patients younger than 18 years who presented to the emergency department. The primary outcome measure was the improvement in the weighted Pediatric Readiness Score. Secondary outcomes were throughput, nursing documentation of vital signs, and pain scores.

RESULTS

A total of N = 2,356 patients met inclusion, of which n = 1,158 (49.2%) were in the preintervention group and n = 1,198 (50.8%) postintervention group. The weighted Pediatric Readiness Score improved by 45.4%. Transfers to a pediatric hospital increased from 4.1% to 8.6% (p = .016). Blood pressure documentation improved slightly from 88.3% to 88.6%. Pain score documentation decreased from 83.9% to 63.1% (p = .008). Pain medication and administration improved from 19.8% to 26.7% (p = .046).

CONCLUSION

We found that participation in the quality improvement initiative was associated with emergency department pediatric readiness improvements.

Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study

OBJECTIVE

To determine the incidence and clinical predictors of invasive bacterial infection (IBI) in well-appearing children who present to the emergency department (ED) with fever and petechiae.

DESIGN

A prospective, observational, multicentre study was conducted in 18 hospitals between November 2017 and October 2019.

PATIENTS

A total of 688 patients were recruited.

MAIN OUTCOME MEASURES

The primary outcome was the presence of IBI. Clinical features and laboratory test results were described and related to the presence of IBI.

RESULTS

Ten IBIs were found (1.5%), comprising eight cases of meningococcal disease and two of occult pneumococcal bacteraemia. Median age was 26.2 months (IQR 15.3-51.2). Blood samples were obtained from 575 patients (83.3%). Patients with an IBI had a shorter time from fever to ED visit (13.5 hours vs 24 hours) and between fever and rash onset (3.5 hours vs 24 hours). Values for absolute leucocyte count, total neutrophil count, C reactive protein and procalcitonin were significantly higher in patients with an IBI. Significantly fewer patients with a favourable clinical status while in the observation unit were found to have an IBI (2/408 patients, 0.5%) than when clinical status was unfavourable (3/18, 16.7%).

CONCLUSIONS

The incidence of IBI among children with fever and petechial rash is lower than previously reported (1.5%). The time from fever to ED visit and to rash onset was shorter in patients with an IBI. Patients with a favourable clinical course during observation in the ED are at lower risk of IBI.

Evaluating workload and manpower planning among pediatric emergency department nurses in Turkey during COVID-19: A cross-sectional, multicenter study

PURPOSE

Quality nursing care in pediatric emergency departments (PEDs) can be achieved only through sustained workload-based manpower planning. The purpose of this paper to evaluate perceptions of workload and manpower planning in the PED setting in Turkey from the nurses' point of view.

DESIGN AND METHODS

This cross-sectional, multicenter study that was conducted among 187 nurses working in a PED setting in Turkey between June and September 2021. Data were collected using a questionnaire that measured nurses' perceptions of workload and manpower planning. The reporting of this study adhered to STROBE guidelines.

RESULTS

The majority of the respondents perceived the number of patients-per-nurse during a shift to be too high, the number of nurses to be insufficient in proportion to the workload, and the nursing manpower-planning to be insufficient and biased. Those with ≤1 year of nursing experience in the PED perceived an increased workload and more burnout during the COVID-19 pandemic period.

CONCLUSIONS

Nurses working in PED setting perceived the workload and manpower planning to be inadequate. In addition, nurses who were less experienced or felt burnout perceived their workload to be increased during the COVID-19 pandemic.

PRACTICE IMPLICATIONS

Further exploration of workload and manpower planning in PEDs is required. Quantifying nurses' perspectives of workload and manpower when managing emergency pediatric patients is essential for designing appropriate interventions to improve the working environment. Future studies should focus on comparing nurses' perceptions with actual workloads and manpower planning in PEDs using appropriate measurement tools.

Pediatric Emergency Cases in the First Year of the COVID-19 Pandemic in a Tertiary-Level Emergency Setting

AIM

Emergency cases are uncommon events in the pediatric emergency setting. This study aimed to evaluate the effect of the Coronavirus disease 2019 (COVID-19) pandemic by describing the number and type of pediatric emergency cases that arrived at the pediatric emergency department (PED) of a tertiary-level children's hospital in Italy.

METHODS

We performed a retrospective study, collecting the main features of pediatric emergency patients who arrived during the first year of the COVID-19 pandemic (March 2020-February 2021) compared to the pre-pandemic period (March 2016-February 2020).

RESULTS

During the study period, 112,168 patients were visited at the PED, and 237 (0.21%) were emergency cases, median age of 4 years (IQR: 1-12). In the first year of the pandemic, 42 children were coded as emergency cases compared to 195 (49/year) during the pre-pandemic period. The proportion of emergency cases was stable (0.27% during the COVID-19 period versus 0.20% during the pre-COVID-19 period, p = 0.19). No differences were found regarding the age, gender, hour of arrival, and outcome of patients. We found a significant decrease in the proportion of emergency cases related to respiratory diseases (9/42, 21.4% during the COVID-19 period versus 83/195 during the pre-COVID-19 period (42.6%), p = 0.01).

CONCLUSION

In conclusion, our data suggest that the pandemic had a more significant impact on respiratory emergency cases than on pediatric emergencies in general.