Hospital admissions (overall, ICU and HD ward) were used as the primary outcome measures.The secondary outcome measure was length of hospitalisation.Frequency histograms of length of hospitalisation were plotted for the different triage acuity levels.Correlation between triage level and dichotomous outcomes was evaluated using chi-square test.
This was a retrospective observational study in which all children who were triaged and attended to at the paediatric ED at KK Women’s and Children’s Hospital, Singapore, from 1 January 2014 to 31 December 2014 were included.Triage is a systematic approach of prioritising patients’ treatment based on the severity of their presenting condition.It also acts as a predictor for the nature and scope of care likely to be required.(1) It is a crucial ‘safety net’ in a busy and often overcrowded emergency department (ED).The hospital’s paediatric ED is dedicated to handling patients aged below 16 years.During the study period, all patients presenting to the ED were triaged by a registered nurse who was trained in the triage system.Studies have shown that the PAT is a reliable tool for the identification of critically ill children.(11) Additionally, it has demonstrated high predictability of a child’s clinical status upon further evaluation.(11) Together with the assessment of triage complaint, vital signs and the SIS,(8) patients were categorised into four acuity levels – Category 1 (Resuscitation), Category 2 plus and Category 2 (Non-resuscitation), and Category 3 (Less urgent, Emergency).The performance of the triage system was evaluated based on its predictive value for admission, relationship with admission rate, level of hospitalisation care required, length of ED stay and length of hospitalisation.To perform triage, all nurses are required to: (a) have more than one year of working experience in the paediatric ED; (b) undergo a structured triage training programme for one month; (c) be satisfactorily evaluated by the nurse clinician and senior physicians in the department; and (d) complete a log of 200 supervised patient cases over a three-month period.Upon the patient’s presentation to the ED, the triage nurse first assessed his/her general appearance, work of breathing and circulation status using the PAT, a validated tool that facilitates rapid assessment of paediatric patients at all levels of illness and injury using visual and auditory cues.Among these, the Emergency Severity Index (ESI), Manchester Triage System (MTS), Australasian Triage Scale, and Canadian Emergency Department Triage and Acuity Scale are the most widely used.(4-7) The Singapore Paediatric Triage Scale (SPTS), currently used in our local tertiary paediatric hospital, is a four-level triage system.Patients are triaged by trained nurses based on three fundamental aspects: quick initial impression of illness severity using the Pediatric Assessment Triangle (PAT); history-taking and evaluation of the presenting complaint; and assessment of behaviour and age-related physiological measurements.