Department of Paediatrics, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil.
Department of Paediatrics, School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
Emerg Med J. 2017 Nov;34(11):711-719. doi: 10.1136/emermed-2016-206058. Epub 2017 Oct 4.
To present a systematic review on the validity of triage systems for paediatric emergency care.
Search in MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), Nursing Database Index (BDENF) and Spanish Health Sciences Bibliographic Index (IBECS) for articles in English, French, Portuguese or Spanish with no time limit. Validity studies of five-level triage systems for patients 0-18 years old were included. Two reviewers performed data extraction and quality assessment as recommended by PRISMA statement.
We found 25 studies on seven triage systems: Manchester Triage System (MTS); paediatric version of Canadian Triage and Acuity Scale (PedCTAS) and its adaptation for Taiwan (paediatric version of the Taiwan Triage and Acuity System); Emergency Severity Index version 4 (ESI v.4); Soterion Rapid Triage System and South African Triage Scale and its adaptation for Bostwana (Princess Marina Triage Scale). Only studies on the MTS used a reference standard for urgency, while all systems were evaluated using a proxy outcome for urgency such as admission. Over half of all studies were low quality. The MTS, PedCTAS and ESI v.4 presented the largest number of moderate and high quality studies. The three tools performed better in their countries or near them, showing a consistent association with hospitalisation and resource utilisation. Studies of all three tools found that patients at the lowest urgency levels were hospitalised, reflecting undertriage.
There is some evidence to corroborate the validity of the MTS, PedCTAS and ESI v.4 for paediatric emergency care in their own countries or near them. Efforts to improve the sensitivity and to minimise the undertriage rates should continue. Cross-cultural adaptation is necessary when adopting these triage systems in other countries.
对儿科急诊分诊系统的有效性进行系统评价。
在 MEDLINE、Cochrane 图书馆、拉丁美洲和加勒比健康科学文献（LILACS）、科学电子图书馆在线（SciELO）、护理数据库索引（BDENF）和西班牙健康科学文献索引（IBECS）中，以英语、法语、葡萄牙语或西班牙语进行无时间限制的检索。纳入 0-18 岁患者五等级分诊系统的有效性研究。两名审查员按照 PRISMA 声明建议进行数据提取和质量评估。
我们发现了 25 项关于 7 种分诊系统的研究：曼彻斯特分诊系统（MTS）；加拿大分诊和 acuity 量表的儿科版（PedCTAS）及其在台湾的改编版（台湾分诊和 acuity 系统的儿科版）；紧急严重程度指数第 4 版（ESI v.4）；Soterion 快速分诊系统和南非分诊量表及其在博茨瓦纳的改编版（Princess Marina 分诊量表）。只有 MTS 的研究使用了紧迫性的参考标准，而所有系统都使用了紧迫性的替代结果进行评估，如入院。超过一半的研究质量较低。MTS、PedCTAS 和 ESI v.4 呈现出最多的中高质量研究。这三种工具在其所在国家或附近国家表现更好，与住院和资源利用呈一致关联。所有三种工具的研究都发现，最低紧迫性级别的患者被住院，反映出分诊不足。
有一些证据支持 MTS、PedCTAS 和 ESI v.4 在其所在国家或附近国家用于儿科急诊的有效性。应该继续努力提高敏感性并尽量减少分诊不足的发生率。在其他国家采用这些分诊系统时需要进行跨文化适应性调整。
