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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2017

Open Access 01-12-2017 | Original research

The danish regions pediatric triage model has a limited ability to detect both critically ill children as well as children to be sent home without treatment – a study of diagnostic accuracy

Authors: Lotte Høeg Hansen, Christian Backer Mogensen, Lena Wittenhoff, Helene Skjøt-Arkil

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2017

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Abstract

Background

The Danish Regions Pediatric Triage model (DRPT) was introduced in 2012 and subsequent implemented in most Danish acute pediatric departments. The aim was to evaluate the validity of DRPT as a screening tool to detect both the most serious acute conditions and the non-serious conditions in the acute referred patients in a pediatric department.

Method

The study was prospective observational, with follow-up on all children with acute referral to pediatric department from October to December 2015. The DRPT was evaluated by comparison to a predefined reference standard and to the actual clinical outcomes: critically ill children and children returned to home without any treatment. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and likelihood for positive and negative test were calculated.

Results

Five hundred fifty children were included. The DRPT categorized 7% very urgent, 28% urgent, 29% standard and 36% non-urgent. The DRPT was equal to the reference standard in 31% of the children (CI: 27-35%). DRPT undertriaged 55% of the children (CI: 51-59%) and overtriaged 14% of the children (CI: 11-17%). For the most urgent patients the sensitivity of DRPT was 31% (CI: 20-48%) compared to the reference standard and 20% (CI: 7-41) for critically ill. For children with non-urgent conditions the specificity of DRPT was 66% (CI: 62-71%) compared to the reference standard and 68% (CI: 62-75%) for the children who went home with no treatment. In none of the analyses, the likelihood ratio of the negative test was less than 0.7 and the positive likelihood ratio only reached more than 5 in one of the analyses.

Discussion

This study is the first to evaluate the DRPT triage system. From the very limited validity studies of other well-established triage systems, it is difficult to judge whether the DRPT performs better or worse than the alternatives. The DRPT errs to the undertriage side. If the sensitivity is low, a number of the sickest children are undetected and this is a matter of concern.

Conclusion

The DRPT is a triage tool with limited ability to detect the critically ill children as well as the children who can be returned to home without any treatment.

Trial registration

Not relevant
Appendix
Available only for authorised users
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Metadata
Title
The danish regions pediatric triage model has a limited ability to detect both critically ill children as well as children to be sent home without treatment – a study of diagnostic accuracy
Authors
Lotte Høeg Hansen
Christian Backer Mogensen
Lena Wittenhoff
Helene Skjøt-Arkil
Publication date
01-12-2017
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-017-0397-6

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