Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2020 Apr 27;35(16):e102. doi: 10.3346/jkms.2020.35.e102.
Previous studies on inter-rater reliability of pediatric triage systems have compared triage levels classified by two or more triage providers using the same information about individual patients. This overlooks the fact that the evaluator can decide whether or not to use the information provided. The authors therefore aimed to analyze the differences in the use of vital signs for triage modification in pediatric triage.
This was an observational cross-sectional study of national registry data collected in real time from all emergency medical services beyond the local emergency medical centers (EMCs) throughout Korea. Data from patients under the age of 15 who visited EMC nationwide from January 2016 to December 2016 were analyzed. Depending on whether triage modifications were made using respiratory rate or heart rate beyond the normal range by age during the pediatric triage process, they were divided into down-triage and non-down-triage groups. The proportions in the down-triage group were analyzed according to the triage provider's profession, mental status, arrival mode, presence of trauma, and the EMC class.
During the study period, 1,385,579 patients' data were analyzed. Of these, 981,281 patients were eligible for triage modification. The differences in down-triage proportions according to the profession of the triage provider (resident, 50.5%; paramedics, 47.7%; specialist, 44.9%; nurses, 44.2%) was statistically significant ( < 0.001). The triage provider's professional down-triage proportion according to the medical condition of the patients showed statistically significant differences except for the unresponsive mental state ( = 0.502) and the case of air transport ( = 0.468).
Down-triage proportion due to abnormal heart rates and respiratory rates was significantly different according to the triage provider's condition. The existing concept of inter-rater reliability of the pediatric triage system needs to be reconsidered.
先前关于儿科分诊系统的观察者间可靠性的研究比较了两位或多位分诊提供者根据相同的个体患者信息分类的分诊级别。这忽略了评估者可以决定是否使用提供的信息这一事实。因此，作者旨在分析儿科分诊中修改分诊时对生命体征的使用差异。
这是一项观察性的横断面研究，使用来自韩国各地急救医疗服务中心（EMC）以外的所有紧急医疗服务的全国登记数据。分析了 2016 年 1 月至 2016 年 12 月期间全国范围内访问 EMC 的 15 岁以下患者的数据。根据儿科分诊过程中年龄超过正常范围的呼吸和心率改变是否进行分诊修改，将患者分为降级组和非降级组。根据分诊提供者的职业、精神状态、到达模式、创伤存在情况和 EMC 级别，对降级组的比例进行分析。
在研究期间，共分析了 1385579 名患者的数据。其中，981281 名患者符合分诊修改条件。根据分诊提供者的职业（住院医师 50.5%、急救医疗技术员 47.7%、专科医生 44.9%、护士 44.2%），降级比例存在显著差异（ < 0.001）。除无反应性精神状态（ = 0.502）和空运病例（ = 0.468）外，患者的医疗状况对分诊提供者的专业降级比例存在统计学差异。
由于异常心率和呼吸率导致的降级比例根据分诊提供者的情况有显著差异。需要重新考虑现有的儿科分诊系统的观察者间可靠性概念。
