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
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 con...
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| Format: | Article |
| Language: | English |
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BMC
2017-05-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13049-017-0397-6 |
| _version_ | 1818039720308899840 |
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| author | Lotte Høeg Hansen Christian Backer Mogensen Lena Wittenhoff Helene Skjøt-Arkil |
| author_facet | Lotte Høeg Hansen Christian Backer Mogensen Lena Wittenhoff Helene Skjøt-Arkil |
| author_sort | Lotte Høeg Hansen |
| collection | DOAJ |
| description | 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 |
| first_indexed | 2024-12-10T08:03:07Z |
| format | Article |
| id | doaj.art-54321f5685124a52b434770ba0d8d799 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-12-10T08:03:07Z |
| publishDate | 2017-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-54321f5685124a52b434770ba0d8d7992022-12-22T01:56:45ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412017-05-012511910.1186/s13049-017-0397-6The 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 accuracyLotte Høeg Hansen0Christian Backer Mogensen1Lena Wittenhoff2Helene Skjøt-Arkil3The Family Center, Hospital of Southern JutlandThe Emergency Department, Hospital of Southern JutlandThe Family Center, Hospital of Southern JutlandThe Emergency Department, Hospital of Southern JutlandAbstract 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 relevanthttp://link.springer.com/article/10.1186/s13049-017-0397-6PediatricTriageReference standardThe Danish Regions Pediatric Triage model |
| spellingShingle | Lotte Høeg Hansen Christian Backer Mogensen Lena Wittenhoff Helene Skjøt-Arkil 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 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Pediatric Triage Reference standard The Danish Regions Pediatric Triage model |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Pediatric Triage Reference standard The Danish Regions Pediatric Triage model |
| url | http://link.springer.com/article/10.1186/s13049-017-0397-6 |
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