Pediatric emergency medicine trisk 0125 0125
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CHAPTER 6 ■ A GENERAL APPROACH TO
TRIAGE
DEBRA A. POTTS, MARY KATE F. ABBADESSA, SHANNON M. GAINES
INTRODUCTION
Children are cared for in all emergency departments (EDs) from general EDs that
see primarily adult patients, to those general EDs with a separate pediatric
section, to pediatric EDs that exist within a pediatric institution. In the last two
decades there has been a considerable increase in ED visits in the United States,
almost a fourth of these visits are by children. In 2015, there were 30 million ED
visits for children less than 18 years of age. As the health burden on emergency
services continues to rise, it is critical to have a reliable method of triaging
children presenting for services.
HISTORY OF TRIAGE
The term “triage” derived from the French word “trier,” to sort, was first used
back in the 18th century to document the severity of injury in warfare. Battlefield
triage eventually made its way into the American medical system and in 1964
Wasserman et al. published the first use of civilian triage in EDs. Subsequently
many institutions, federal agencies, and emergency medical systems have
continued to study and refine triage systems in the United States.
CURRENT TRIAGE SYSTEMS
Pediatric triage requires rapid assessment of those presenting to the ED including
determination of severity of illness or injury, assignment of acuity level, and
anticipation of appropriate emergency care resources needed. With limited
resources available, the goal of the triage process is “right patient, right provider,
right care, right time,” which demands a standardized approach. The American
College of Emergency Physicians (ACEP) and the Emergency Nurses
Association (ENA) have recommended that EDs use a reliable and valid fivelevel triage system for prioritizing the care of children presenting to the ED. In
2010, the ACEP and ENA, based on expert consensus of currently available
evidence, supported the adoption of a reliable, valid five-level triage system such
as the Emergency Severity Index (ESI). Following the release of this position
statement, the number of EDs using the five-level ESI triage system increased
significantly.
