Canadian Paediatric Triage and Acuity Scale: assessment in a European pediatric emergency department

Objectives: To assess the functionality and reliability of a computerized version of the Canadian Paediatric Triage and Acuity Scale (PaedCTAS) in a European pediatric emergency department. Methods: Retrospective review of emergency cases in 2007. We collected data on the seriousness of each emergency, mean patient stay in the department, rate of admission, and tests ordered. The reliability of the scale was estimated by calculating the agreement between raters' theoretical classification of cases and the reference assessment. Results: A total of 57617 emergencies were analyzed. The distribution by levels of severity were as follows: level 1, 0.07%; level 2, 1.73%; level 3, 43.1%; level 4, 50%; and level 5, 5.1%. The frequency of orders for tests ranged from 63.6% at level 1 to 8% at level 5 (P<.01). The mean duration of stay increased progressively from 72 minutes for level 5 to 373 minutes for level 1. Admission rates also differed by severity level (from 84% at level 1 to 1.6% at level 5, P<.001). The reliability study showed that triage based on the Paediatric Assessment Triangle was exact in 93.6% of the cases; the K index was 0.77 (95% confidence interval [Cl] 0.75-0.79). The scale correctly assigned the level of severity or included only a slight discrepancy in 80.3% of the cases. The kappa index was 0.47 (95% Cl, 0.46-0.48). Conclusions: The PaedCTAS seems to be applicable to European pediatric emergency department use although certain features of the scale could be improved for application by our emergency department. [Emergencias 2010;22:355-360]