Paediatric CTAS

Letters

CJEM 2002;4(1):3-6

To the editor:

Our centre is one of the busiest urban pediatric emergency departments (EDs) in North America, with more than 65 000 visits annually. We implemented the Canadian Paediatric Triage and Acuity Scale (PaedCTAS) 5 months ago [since published as a supplement to the October 2001 issue¹ of CJEM] and we are generally pleased with it; it has been quite easy to use. However, from the time it was discussed at meetings of the Canadian Paediatric Society and Canadian Association of Emergency Physicians, we have had concerns about the infection category. Our experience is proving that these concerns are real.

Lumping all children "aged 3 to 36 months with fever" in the Level III triage category is unrealistic. Febrile children in this age group represent the most frequent reason for consultation at our centre, and most have relatively benign viral illnesses. If we apply the PaedCTAS consistently, these patients disproportionately expand the Level III triage category, forcing potentially sicker patients with asthma, possible appendicitis or moderate allergic reactions (who should be seen earlier) to wait longer than necessary.

In general EDs with less pediatric experience it may be acceptable to lump all of these children into Level III, but in centres with pediatric triage expertise it is important to redefine this category based on other established criteria, so that some patients can be moved into higher or lower triage levels. Our triage nurses now do this informally without benefit of objective criteria, by placing selected Level III patients ahead of others who arrived earlier. Utility and relevance are critical characteristics of a triage tool and, at least in the infection category, we feel that the PaedCTAS has failed.

The Canadian Emergency Department Triage and Acuity Scale (CTAS)² has become a mandatory triage tool in our provincial EDs. Pediatric centres need an appropriate triage acuity scale to help us gather reliable information and define our acuity, resource level and performance. Before recommending the PaedCTAS as a national standard, its reliability and validity must be demonstrated.

Sylvie Bergeron, MD  
Medical director 
Benoit Bailey, MD 
Research coordinator 
Paediatric Emergency Department 
Hôpital Ste-Justine 
Montreal, Que.

References

1. Warren D, Jarvis A, Leblanc L, and the National Triage Task Force members. Canadian Paediatric Triage and Acuity Scale: implementation guidelines for emergency departments. CJEM 2001;3(4 Suppl):S1-27.
2. Beveridge R, Clarke B, Janes L, Savage N, Thompson J, Dodd G, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. CJEM 1999;1(3 Suppl):S1-24.