Emergency pediatric patients and use of the pediatric assessment triangle tool (PAT): a scoping review.
Children; emergency medicine; review
Pediatric assessment triangle
Pediatrics or paediatric
Journal
BMC emergency medicine
ISSN: 1471-227X
Titre abrégé: BMC Emerg Med
Pays: England
ID NLM: 100968543
Informations de publication
Date de publication:
04 Sep 2024
04 Sep 2024
Historique:
received:
19
07
2023
accepted:
08
08
2024
medline:
4
9
2024
pubmed:
4
9
2024
entrez:
3
9
2024
Statut:
epublish
Résumé
We conducted a scoping review of the evidence for the use of the Pediatric Assessment Triangle (PAT) tool in emergency pediatric patients, in hospital and prehospital settings. We focused on the psychometric properties of the PAT, the reported impact, the setting and circumstances for tool implementation in clinical practice, and the evidence on teaching the PAT. We followed the Joanna Briggs Institute methodology for scoping reviews and registered the review protocol. We searched MEDLINE, PubMed Central, the Cochrane Library, Epistemonikos, Scopus, CINAHL, Grey literature report, Lens.org, and the web pages of selected emergency pediatrics organizations in August 2022. Two reviewers independently screened and extracted data from eligible articles. Fifty-five publications were included. The evidence suggests that the PAT is a valid tool for prioritizing emergency pediatric patients, guiding the selection of interventions to be undertaken, and determining the level of care needed for the patient in both hospital and prehospital settings. The PAT is reported to be fast, practical, and useful potentially impacting overcrowded and understaff emergency services. Results highlighted the importance of instruction prior using the tool. The PAT is included in several curricula and textbooks about emergency pediatric care. This scoping review suggests there is a growing volume of evidence on the use of the PAT to assess pediatric emergency patients, some of which might be amenable to a systematic review. Our review identified research gaps that may guide the planning of future research projects. Further research is warranted on the psychometric properties of the PAT to provide evidence on the tool's quality and usefulness. The simplicity and accuracy of the tool should be considered in addressing the current healthcare shortages and overcrowding in emergency services. Open Science Framework; 2022. https://osf.io/vkd5h/.
Sections du résumé
BACKGROUND
BACKGROUND
We conducted a scoping review of the evidence for the use of the Pediatric Assessment Triangle (PAT) tool in emergency pediatric patients, in hospital and prehospital settings. We focused on the psychometric properties of the PAT, the reported impact, the setting and circumstances for tool implementation in clinical practice, and the evidence on teaching the PAT.
METHODS
METHODS
We followed the Joanna Briggs Institute methodology for scoping reviews and registered the review protocol. We searched MEDLINE, PubMed Central, the Cochrane Library, Epistemonikos, Scopus, CINAHL, Grey literature report, Lens.org, and the web pages of selected emergency pediatrics organizations in August 2022. Two reviewers independently screened and extracted data from eligible articles.
RESULTS
RESULTS
Fifty-five publications were included. The evidence suggests that the PAT is a valid tool for prioritizing emergency pediatric patients, guiding the selection of interventions to be undertaken, and determining the level of care needed for the patient in both hospital and prehospital settings. The PAT is reported to be fast, practical, and useful potentially impacting overcrowded and understaff emergency services. Results highlighted the importance of instruction prior using the tool. The PAT is included in several curricula and textbooks about emergency pediatric care.
CONCLUSIONS
CONCLUSIONS
This scoping review suggests there is a growing volume of evidence on the use of the PAT to assess pediatric emergency patients, some of which might be amenable to a systematic review. Our review identified research gaps that may guide the planning of future research projects. Further research is warranted on the psychometric properties of the PAT to provide evidence on the tool's quality and usefulness. The simplicity and accuracy of the tool should be considered in addressing the current healthcare shortages and overcrowding in emergency services.
REVIEW REGISTRATION
BACKGROUND
Open Science Framework; 2022. https://osf.io/vkd5h/.
Identifiants
pubmed: 39227775
doi: 10.1186/s12873-024-01068-w
pii: 10.1186/s12873-024-01068-w
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
158Informations de copyright
© 2024. The Author(s).
Références
Kobusingye OC, Hyder AA, Bishai D, Joshipura M, Hicks ER, Mock C. Emergency medical services. In: Jamison DT, Breman JG, Measham AR, et al, editors. Disease control priorities in developing countries 2nd ed. Washington, DC: International Bank for Reconstruction and Development / The World Bank; 2006. https://www.ncbi.nlm.nih.gov/books/NBK11744/ .
World Health Organization (WHO). WHO Emergency care system framework infographics Geneva: World Health Organization; 2018. Available from: https://www.who.int/publications/i/item/who-emergency-care-system-framework . Updated 2 May 2018; cited 2023 11 April.
Andersen K, Mikkelsen S, Jørgensen G, Zwisler ST. Paediatric medical emergency calls to a Danish emergency medical dispatch centre: a retrospective, observational study. Scand J Trauma Resusc Emerg Med. 2018;26(1):2.
pubmed: 29304841
pmcid: 5756442
doi: 10.1186/s13049-017-0470-1
Lee LK, Porter JJ, Mannix R, Rees CA, Schutzman SA, Fleegler EW, et al. Pediatric traumatic injury emergency department visits and management in US children’s hospitals from 2010 to 2019. Ann Emerg Med. 2022;79(3):279–87.
pubmed: 34839942
doi: 10.1016/j.annemergmed.2021.10.008
Fuchs S. The origins and evolution of emergency medical services for children. Pediatr Ann. 2021;50(4):e150–4.
pubmed: 34039172
doi: 10.3928/19382359-20210316-01
Fuchs S, Yamamoto L, editors. APLS: the pediatric emergency medicine resource. 5th ed. Burlington: Jones & Bartlett Learning; 2012. p. 538.
Houston R, Pearson GA. Ambulance provision for children: a UK national survey. Emerg Med J. 2010;27(8):631–6.
pubmed: 20515914
doi: 10.1136/emj.2009.088880
McDermott KW, Stocks C, Freeman WJ. Overview of pediatric emergency department visits, 2015: Statistical Brief #242. Rockville: Agency for Healthcare Research and Quality; 2018.
Nesje E, Valoy NN, Kruger AJ, Uleberg O. Epidemiology of paediatric trauma in Norway: a single-trauma centre observational study. Int J Emerg Med. 2019;12(1):18.
pubmed: 31366380
pmcid: 6670199
doi: 10.1186/s12245-019-0236-9
United Nations Children's Fund (UNICEF). Levels and trends in child mortality. Report 2022. New York: UNICEF; 2023. Available from: https://data.unicef.org/resources/levels-and-trends-in-child-mortality/ .
Jeruzal JN, Boland LL, Frazer MS, Kamrud JW, Myers RN, Lick CJ, et al. Emergency medical services provider perspectives on pediatric calls: a qualitative study. Prehosp Emerg Care. 2019;23(4):501–9.
pubmed: 30482077
doi: 10.1080/10903127.2018.1551450
Nordén C, Hult K, Engström Å. Ambulance nurses’ experiences of nursing critically ill and injured children: a difficult aspect of ambulance nursing care. Int Emerg Nurs. 2014;22(2):75–80.
pubmed: 23711561
doi: 10.1016/j.ienj.2013.04.003
Hansen M, Meckler G, Dickinson C, Dickenson K, Jui J, Lambert W, et al. Children’s safety initiative: a national assessment of pediatric educational needs among emergency medical services providers. Prehosp Emerg Care. 2015;19(2):287–91.
pubmed: 25296191
doi: 10.3109/10903127.2014.959223
Li J, Roosevelt G, McCabe K, Preotle J, Pereira F, Takayesu JK, et al. Critically ill pediatric case exposure during emergency medicine residency. J Emerg Med. 2020;59(2):278–85.
pubmed: 32536497
doi: 10.1016/j.jemermed.2020.04.047
Ralston ME, Zaritsky AL. New opportunity to improve pediatric emergency preparedness: pediatric emergency assessment, recognition, and stabilization course. Pediatrics. 2009;123(2):578–80.
pubmed: 19171625
doi: 10.1542/peds.2008-0714
Roukema J, Steyerberg EW, van Meurs A, Ruige M, van der Lei J, Moll HA. Validity of the manchester triage system in paediatric emergency care. Emerg Med J. 2006;23(12):906.
pubmed: 17130595
pmcid: 2564249
doi: 10.1136/emj.2006.038877
Yates MT, Ishikawa T, Schneeberg A, Brussoni M. Pediatric Canadian Triage and Acuity Scale (PaedsCTAS) as a measure of injury severity. Int J Environ Res Public Health. 2016;13(7):659.
pubmed: 27399743
pmcid: 4962200
doi: 10.3390/ijerph13070659
Thim T, Krarup NH, Grove EL, Rohde CV, Lofgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med. 2012;5:117–21.
pubmed: 22319249
pmcid: 3273374
doi: 10.2147/IJGM.S28478
Shah MN. The formation of the emergency medical services system. Am J Public Health. 2006;96(3):414–23.
pubmed: 16449600
pmcid: 1470509
doi: 10.2105/AJPH.2004.048793
Fuchs S, McEvoy M, editors. Pediatric education for prehospital professionals. 4th ed. Burlington: Jones & Bartlett Learning; 2021. p. 490.
Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: scoping reviews. In: JBI manual for evidence synthesis. Joanna Briggs Institute; 2020. Available from: https://synthesismanual.jbi.global .
Tørisen TAG, Glanville J, Loaiza-Betancur AF, Bidonde J. Emergency pediatric patients and use of the pediatric assessment triangle (PAT) tool. Protocol for a scoping review. Charlottesville: Open Science Framework; 2022. https://www.osf.io/vkd5h .
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.
pubmed: 30178033
doi: 10.7326/M18-0850
Fernandez A, Benito J, Mintegi S. Is this child sick? Usefulness of the pediatric assessment triangle in emergency settings. J Pediatr (Rio J). 2017;93(Suppl 1):60–7.
pubmed: 28846853
doi: 10.1016/j.jped.2017.07.002
World Bank. New World Bank country classifications by income level: 2022-2023. The World Bank Group; 202. Available from: https://blogs.worldbank.org/opendata/new-world-bank-country-classifications-income-level-2022-2023 .
Avilés-Martinez KI, López-Enríquez A, Luévanos-Velázquez A, Jiménez-Pérez BA, García-Armenta MB, Ceja-Moreno H, et al. Triage, priorization tools of pediatric emergency room. Acta Pediatr de Mex. 2016;37(1):4–16.
Gausche-Hill M, Eckstein M, Horeczko T, McGrath N, Kurobe A, Ullum L, et al. Paramedics accurately apply the pediatric assessment triangle to drive management. Prehosp Emerg Care. 2014;18(4):520–30.
pubmed: 24830831
doi: 10.3109/10903127.2014.912706
Horeczko T, Enriquez B, McGrath NE, Gausche-Hill M, Lewis RJ. The pediatric assessment triangle: accuracy of its application by nurses in the triage of children. J Emerg Nurs. 2013;39(2):182–9.
pubmed: 22831826
doi: 10.1016/j.jen.2011.12.020
Ma X, Liu Y, Du M, Ojo O, Huang L, Feng X, et al. The accuracy of the pediatric assessment triangle in assessing triage of critically ill patients in emergency pediatric department. Int Emerg Nurs. 2021;58.
pubmed: 34333333
doi: 10.1016/j.ienj.2021.101041
Fernández A, Ares MI, Garcia S, Martinez-Indart L, Mintegi S, Benito J. The validity of the pediatric assessment triangle as the first step in the triage process in a pediatric emergency department. Pediatr Emerg Care. 2017;33(4):234–8.
pubmed: 27176906
doi: 10.1097/PEC.0000000000000717
Lugo S, Pavlicich V. Application of the pediatric assessment triangle to the triage classification system in an emergency department. Rev Bol Ped. 2014;53(2):88–93.
Fernández A, Pijoan JI, Ares MI, Mintegi S, Benito FJ. Canadian paediatric triage and acuity scale: assessment in a European pediatric emergency department. Emergencias. 2010;22(5):355–60.
Ecclesia FG, Alonso Cadenas JA, Gómez B, Gangoiti I, Hernández-Bou S, de la Torre EM. Late-onset group B streptococcus bacteremia evaluated in the pediatric emergency department and risk factors for severe infection. Pediatr Infect Dis J. 2022;41(6):455–9.
pubmed: 35446825
doi: 10.1097/INF.0000000000003520
Gomez B, Hernandez-Bou S, Garcia-Garcia JJ, Mintegi S. Bacteremia in previously healthy children in emergency departments: clinical and microbiological characteristics and outcome. Eur J Clin Microbiol Infect Dis. 2015;34(3):453–60.
pubmed: 25252630
doi: 10.1007/s10096-014-2247-z
Sánchez IA, Cotanda CP, Casas MM, de la Maza VTS, Cubells CL. Profile of the child seen in the resuscitation room. Rev Esp Salud Publica. 2019;93.
Shiva GS, Kumar VS, Kumar PR, Subramanian SB. A study on the role of paediatric assessment triangle, clinical scoring and serum lactate in the management of septic shock in children. Int J Contemp Pediatr. 2019;6(5):2037.
doi: 10.18203/2349-3291.ijcp20193720
Macnab AJ. Objective assessment and communication of the physiologic status of the sick infant. Can J Midwif Res Pract. 2004;3(2):7–12.
doi: 10.22374/cjmrp.v3i2.173
Mierek C, Nacca N, Scott JM, Wojcik SM, D’Agostino J, Dougher K, et al. View from the door: making pediatric transport decisions based on first impressions. JEMS. 2010;35(7):68–9, 71, 3, 5, 7, 9, 81.
pubmed: 20643291
Arroabarren E, Alvarez-Garcia J, Anda M, de Prada M, Ponce MC, Palacios M. Quality of the triage of children with anaphylaxis at the emergency department. Pediatr Emerg Care. 2021;37(1):17–22.
pubmed: 29768291
doi: 10.1097/PEC.0000000000001442
Alp EE, Dalgic N, Yilmaz V, Altuntas Y, Ozdemir HM. Evaluation of patients with suspicion of COVID-19 in pediatric emergency department. Sisli Etfal Hastan Tip Bul. 2021;55(2):179–87.
pubmed: 34349593
pmcid: 8298069
Derİnöz-Güleryüz O. In-hospital pediatric patient transfers to the pediatric emergency department. Cukurova Med J. 2022;47(1):332–40.
doi: 10.17826/cumj.993559
Kawai R, Nomura O, Tomobe Y, Morikawa Y, Miyata K, Sakakibara H, et al. Retrospective observational study indicates that the paediatric assessment triangle may suggest the severity of Kawasaki disease. Acta Paediatr. 2018;107(6):1049–54.
pubmed: 29385646
doi: 10.1111/apa.14249
Paniagua N, Elosegi A, Duo I, Fernandez A, Mojica E, Martinez-Indart L, et al. Initial asthma severity assessment tools as predictors of hospitalization. J Emerg Med. 2017;53(1):10–7.
pubmed: 28416251
doi: 10.1016/j.jemermed.2017.03.021
Alonso Cadenas JA, Corredor Andrés B, Andina Martínez D, et al. Characteristics and risk factors for admission in children undergoing hematopoietic cell transplantation in a pediatric emergency department. Authorea. 2021. https://doi.org/10.22541/au.163253914.42579466/v1 .
Rodríguez Borbolla FJ, Sancha Herrera ML, Ortiz Angulo E, Pulido PP. Implementación del sistema de clasificación en la Unidad de Urgencias Pediátricas del Hospital Marqués de Valdecilla. Fundacion de Enfermeria de Cantabria. 2013;2(9):26–31.
Suárez M, Jaime M. Utilidad del triángulo de evaluación pediátrica en un servicio de emergencia pediátrica. Boletin Medico de Postgrado. 2018;34(2):39–45.
Ogden K. The use of the paediatric assessment triangle in the management of the sick child. Emerg Med J. 2016;33(9):e4.
doi: 10.1136/emermed-2016-206139.16
Romig LE. PREP for peds-patient physiology, rescuer responses, equipment, protocols. Size-up & approach tips for pediatric calls. JEMS. 2001;26(5):24–33.
pubmed: 11357749
Horeczko T, Gausche-Hill M. The paediatric assessment triangle: a powerful tool for the prehospital provider. J Paramed Pract. 2011;3(1):20–5.
doi: 10.12968/jpar.2011.3.1.20
Walker A, Hanna A. Kids really are just small adults: utilizing the pediatric triangle with the classic ABCD approach to assess pediatric patients. Cureus. 2020;12(3): e7424.
pubmed: 32337144
pmcid: 7182162
Morilla L, Morel Z, Pavlicich V. Clinical characteristics of pediatric patients with COVID-19 in an emergency department. Pediatría (Asunción). 2020;47(3):124–31.
doi: 10.31698/ped.47032020002
Akindolire AE, Tongo OO. Paediatric critical care needs assessment in a tertiary facility in a developing country. Niger J Paediatr. 2018;45(1):10–4.
doi: 10.4314/njp.v45i1.3
Anitha GF, Velmurugan L, Sangareddi S, Nedunchelian K, Selvaraj V. Effectiveness of flow inflating device in providing Continuous Positive Airway Pressure for critically ill children in limited-resource settings: a prospective observational study. Indian J Crit Care Med. 2016;20(8):441–7.
pubmed: 27630454
pmcid: 4994122
doi: 10.4103/0972-5229.188171
Benito J, Luaces-Cubells C, Mintegi S, Manrique Martínez I, De la Torre EM, Miguez Navarro C, et al. Evaluation and impact of the “advanced pediatric life support” course in the care of pediatric emergencies in Spain. Pediatr Emerg Care. 2018;34(9):628–32.
pubmed: 28609331
doi: 10.1097/PEC.0000000000001038
Guerrero-Márquez G, Míguez-Navarro MC. The physiological diagnosis missing in the pediatric assessment triangle. Pediatr Emerg Care. 2021;37(11).
pubmed: 34731880
doi: 10.1097/PEC.0000000000002550
Jayashree M, Singhi SC. Initial assessment and triage in ER. Indian J Pediatr. 2011;78(9):1100–8.
pubmed: 21553208
doi: 10.1007/s12098-011-0411-3
Gonzalez Brabin A, Martín Rivada Á, Cabrero Hernández M, Cañedo Villarroya E. MIR clinical case. Make your diagnosis: a newborn with decreased intake and lethargy. Pediatr Integ. 2019;23(3):162–5.
Simon Junior H, Schvartsman C, Sukys GA, Farhat SCL. Pediatric emergency triage systems. Rev Paul Pediatr. 2022;41:e2021038.
pubmed: 35858040
Gehri M, Flubacher P, Chablaix C, Pediatrics Curchod P. The PAT: a simple and rapid tool for the assessment of the severely ill or injured child. Rev Med Suisse. 2011;3(277):64–5.
Dieckmann RA. New assessment model saves critical time in pediatric emergencies. AAP News. 1999;15(2):22.
Mendes M, McCormick T. Pediatric resuscitation. In: Rose E, editor. Pediatric emergencies: a practical, clinical guide. United kingdom: Oxford Oxford University Press; 2020. p. 67–74.
doi: 10.1093/med/9780190073879.003.0008
Fuchs S. The special needs of children. In: Cone D, Brice JH, Delbridge TR, Myers JB, editors. Emergency medical services: clinical practice and systems oversight. 3rd ed. Hoboken: Wiley-Blackwell; 2021. p. 379–85.
Dieckmann RA, Brownstein D, Gausche-Hill M. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010;26(4):312–5.
pubmed: 20386420
doi: 10.1097/PEC.0b013e3181d6db37
Chiu Y-C, Liu S-Y, Yen T-A, Chen Y-Y, Yang C-W, Chu T-S, et al. Application of high-fidelity patient simulation in the teaching of pediatric primary assessment and management - is it feasible for medical students? J Med Educ. 2018;22(1):17–27.
Hansen M, Spiro DM. Teaching the pediatric assessment triangle using online video cases. Ann Emerg Med. 2013;62(5):S172.
doi: 10.1016/j.annemergmed.2013.06.043
Patten J. Goal-directed management of shock in children [thesis]. Zagreb: University of Zagreb School of Medicine; 2015.
Tagg A. Paediatric Assessment Triangle [internet]: Don't forget the bubbles; 2019 [updated 06/02/2023. Available from: https://dontforgetthebubbles.com/the-paediatric-assessment-triangle/ .
Furmick J, Malburg L, Leetch A. Pediatric airway management. Pediatr Emerg Med Rep. 2017;22(10):1–17.
Khouli M. Injuries in children and general principles of management. Mexican J Med Res ICSA. 2015;3(5). https://doi.org/10.29057/mjmr.v3i5.1835 .
Pérez LFT, Bouza MR, Valle AML, Hoyos JB, Vera CV. Emergency management: introduction. Revista Infancia y Salud. 2019;1(2). Available from: http://rinsad.uca.es/ojs3/index.php/rinsad/article/view/20 .
Rochat MK, Gehri M. Pediatric emergencies - the essential, briefly, for general practitioners. Ther Umsch. 2013;70(11):653–60.
pubmed: 24168799
doi: 10.1024/0040-5930/a000461
Yock Corrales A, Starr M. Assessment of the unwell child. Aust Fam Physician. 2010;39(5):270–5.
Agbim CA, Wang NE, Lee M. Respiratory distress in pediatric patients. Pediatr Emerg Med Rep. 2018;23(4):41–55.
Güler E, Özkaya AK. Recognition of shock in children: review. Turkiye Klinikleri Pediatri. 2015;24(2):45–50.
doi: 10.5336/pediatr.2014-41800
Ramser M. The febrile child in respiratory distress. Praxis. 2017;106(4):201–7.
pubmed: 28211751
doi: 10.1024/1661-8157/a002601
Singh A, Frenkel O. Evidence-based emergency management of the pediatric airway. Pediatr Emerg Med Pract. 2013;10(1):1–25.
pubmed: 26505568
Neumar RW, Blomkalns AL, Cairns CB, D’Onofrio G, Kuppermann N, Lewis RJ, et al. Emergency medicine research: 2030 strategic goals. Acad Emerg Med. 2022;29(2):241–51.
pubmed: 34363718
doi: 10.1111/acem.14367
Grant D. The future of paediatric simulation. In: Cheng A, Grant V, editors. Comprehensive healthcare simulation: Pediatric Edition: Springer International Publishing. 2016. p. 401.
doi: 10.1007/978-3-319-24187-6_31
Hansoti B, Jenson A, Keefe D, De Ramirez SS, Anest T, Twomey M, et al. Reliability and validity of pediatric triage tools evaluated in low resource settings: a systematic review. BMC Pediatr. 2017;17(1):37.
pubmed: 28122537
pmcid: 5267450
doi: 10.1186/s12887-017-0796-x
Slusher T, Bjorklund A, Aanyu HT, Kiragu A, Philip C. The assessment, evaluation, and management of the critically ill child in resource-limited international settings. J Pediatr Intensive Care. 2017;6(1):66–76.
pubmed: 31073427
Muttalib F, González-Dambrauskas S, Lee JH, Steere M, Agulnik A, Murthy S, et al. Pediatric emergency and critical care resources and infrastructure in resource-limited settings: a multicountry survey. Crit Care Med. 2021;49(4):671–81.
pubmed: 33337665
doi: 10.1097/CCM.0000000000004769