AUTHOR=Tran Antoine , Valo Petri , Rouvier Camille , Dos Ramos Emmanuel , Freyssinet Emma , Baranton Emma , Haas Olivier , Haas Hervé , Pradier Christian , Gentile Stéphanie TITLE=Validation of the Computerized Pediatric Triage Tool, pediaTRI, in the Pediatric Emergency Department of Lenval Children's Hospital in Nice: A Cross-Sectional Observational Study JOURNAL=Frontiers in Pediatrics VOLUME=10 YEAR=2022 URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.840181 DOI=10.3389/fped.2022.840181 ISSN=2296-2360 ABSTRACT=Introduction

A reliable pediatric triage tool is essential for nurses working in pediatric emergency departments to quickly identify children requiring priority care (high-level emergencies) and those who can wait (low-level emergencies). In the absence of a gold standard in France, the objective of our study was to validate our 5-level pediatric triage tool –pediaTRI– against the reference tool: the Pediatric Early Warning Score (PEWS) System.

Materials and Methods

We prospectively included 100,506 children who visited the Pediatric Emergency Department at Lenval Children's Hospital (Nice, France) in 2016 and 2017. The performance of pediaTRI to identify high-level emergencies (severity levels 1 and 2) was evaluated in comparison with a PEWS ≥ 4/9. Data from 2018–19 was used as an independent validation cohort.

Results

pediaTRI agreed with the PEWS score for 84,896 of the patients (84.5%): 15.0% (14.8–15.2) of the patients were over-triaged and 0.5% (0.5–0.6) under-triaged compared with the PEWS score. pediaTRI had a sensitivity of 76.4% (74.6–78.2), a specificity of 84.7% (84.4–84.9), and positive and negative likelihood ratios of 5.0 (4.8–5.1) and 0.3 (0.3–0.3), respectively, for the identification of high-level emergencies. However, the positive likelihood ratios were lower for patients presenting with a medical complaint [4.1 (4.0–4.2) v 10.4 (7.9–13.7 for trauma), and for younger children [1.2 (1.1–1.2) from 0 to 28 days, and 1.9 (1.8–2.0) from 28 days to 3 months].

Conclusion

pediaTRI has a moderate to good validity to triage children in a Pediatric Emergency Department with a tendency to over-triage compared with the PEWS system. Its validity is lower for younger children and for children consulting for a medical complaint.