Objective To present a systematic review on the reliability of triage systems for paediatric emergency care.
Methods A search of MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online, Nursing Database Index and Spanish Health Sciences Bibliographic Index for articles in English, French, Portuguese or Spanish was conducted to identify reliability studies of five-level triage systems for patients aged 0–18 years published up to April 2018. Two reviewers performed study selection, data extraction and quality assessment as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Results Twenty studies on nine triage systems were selected: the National Triage System (n=1); the Australasian Triage Scale (n=3); the paediatric Canadian Triage and Acuity Scale (PedCTAS) (n=5); the Manchester Triage System (MTS) (n=1); the Emergency Severity Index (ESI) (n=5); an adaptation of the South African Triage Scale for the Princess Marina Hospital in Botswana (n=1); the Soterion Rapid Triage System (n=1); the Rapid Emergency Triage and Treatment System-paediatric version (n=2); the Paediatric Risk Classification Protocol (n=1). Ten studies were performed with actual patients, while the others used hypothetical scenarios. The studies were rated low (n=14) or moderate (n=6) quality. Kappa was the most used statistic, although many studies did not specify the weighting. PedCTAS, MTS and ESI V.4 exhibited substantial to almost perfect agreement in moderate quality studies.
Conclusions There is some evidence on the reliability of the PedCTAS, MTS and ESI V.4, but most studies are limited to the countries where they were developed. Efforts are needed to improve the quality of the studies, and cross-cultural adaptation of those tools is recommended in countries with different professional qualification and sociocultural contexts.
- emergency departments
- australasian triage scale
- canadian triage and acuity scale
- manchester triage system
- emergency severity index
- south african triage scale
- rapid triage system
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Contributors MCM-B conceived and designed the study, participates as reviewer of the search of the literature, the selection of the articles and the extraction and analysis of data, drafted the initial manuscript and approved the final manuscript as submitted. AP-B participated as a second reviewer in the selection of the articles, reviewed and revised the manuscript and approved the final manuscript as submitted. JRR participated as a second reviewer in the extraction of data, in the design of the quality assessment instruments, in the assessment of the risk of bias of the selected articles and approved the final manuscript as submitted. CdSL supervised the conduct of the study, reviewed and revised the manuscript and approved the final manuscript as submitted.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.