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Triaging in Acutely Ill Child

Nikhilnag S. Punneshetty* , G.M. Pranam** , Usha Pranam** , G.A. Manjunath***

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Indian Journal of Trauma and Emergency Pediatrics 8(1):p 31-34, January - April 2016. | DOI: DOI: https://dx.doi.org/10.21088/ijtep.2348.9987.8116.5

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Abstract

 Objective: To assess the triage scoring system evolved by N. Kumar et al.  For severity of illness and outcome based on clinical variables related to systemic inflammatory response syndrome (SIRS) and advanced pediatric life support. Design: Prospective studyconducted in a tertiary-care hospital. Methods:   A Prospective observational study was done at tertiary care center of Navodaya Medical College and Hospital during the period of October 2013 to October 20015. All children admitted during this period in pediatric ward and pediatric ICU were included in the study and a triage score would be applied to each child at the time of first contact. The triage score consisted of temperature, heart rate, respiratory rate, blood pressure, capillary filling time, oxygen saturation (SpO2) based on systemic inflammatory response syndrome and sensorium level was assessed on AVPU score. Each study variable was scored as 0 or 1 (normal or abnormal) and a total score for each child obtained. The outcome at discharge was correlated with the study variables and the total score. ROC curve analysis was performed to see the overall predictive ability of the score as well as a cut off at which maximum discrimination occurred. Results: Of 252 children studied 36 died. Of the  7 variables 6 variables were abnormal in the study subjects. Except temperature all other variables showed significant association with mortality (p<0.05). Mortality increased with increase in the number of abnormal variables; 1%, 8.1%, 22.9%, 45.5%, 62.5%, 64.3% and 100% for scores of 0, 1, 2,3,4,5 and 6 respectively. Children with a score of 2 or more had significant higher mortality. The area under the ROC curve was 0.900, indicating that overall 90% of the subject could be predicted correctly.  Conclusion: Our study concluded that for triage scoring, any child with 2 or more abnormal clinical variables at the time of first contact should be taken as serious that might lead to death.

 Keywords: Intensive Care; Systemic Inflammatory Response Syndrome; Triage Score; Acutely Ill Child.

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DOI: DOI: https://dx.doi.org/10.21088/ijtep.2348.9987.8116.5

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