Remote triage in paediatric critical care: A Canadian provincial-wide cohort study

Atsushi Kawaguchi; Gonzalo Garcia Guerra; Eli Gilad; Praveen Jain; Allan DeCaen

doi:10.1093/pch/pxaa036

Remote triage in paediatric critical care: A Canadian provincial-wide cohort study

Paediatr Child Health. 2020 Apr 9;26(3):166-172. doi: 10.1093/pch/pxaa036. eCollection 2021 Jun.

Authors

Atsushi Kawaguchi^{1

2}, Gonzalo Garcia Guerra³, Eli Gilad⁴, Praveen Jain⁵, Allan DeCaen³

Affiliations

¹ Department of Pediatrics, University of Montreal CHU Sainte-Justine, Montreal, Quebec.
² Department of Pediatrics, University of Ottawa Children's Hospital Eastern Ontario, Ottawa, Ontario.
³ Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta.
⁴ Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta.
⁵ Department of Emergency Medicine, University of Alberta, Edmonton, Alberta.

Abstract

Objective: To describe remote triage of 'potentially' critically ill or injured children in a western Canadian province and to examine the associated factors with 'missings' in vital sign items recorded in centralized telephone triage consultations.

Methods: This is a provincial-wide prospective cohort study. We included all children under 17 years of age consulted through the central transport coordination centres in Alberta from June 2016 to July 2017. We labeled a value as 'missing' when the actual value was not identified in the audio records.

Results: In total, 429 cases were included in this study. The median duration of triage calls was 6.8 minutes. Although the patients' demographics and primary diagnoses were similar, backgrounds of the referring physicians and hospitals were significantly different between the two cohorts (i.e., patients referred to Calgary versus Edmonton). The proportion of 'missings' among the vital sign items varied significantly, in which capillary refilling time (60%), pupils (86%), Glasgow Coma Scale (GCS) (79%), and level of respiratory effort (50%) were not well recorded, whereas heart rate (proportion of 'missings': 12%), SpO₂ (20%), and respiratory rate (26%) were recorded reasonably well. The lower proportion of 'missings' was observed in older aged patients for several vital sign items including systolic blood pressure and GCS.

Conclusions: The proportion of missing vital signs recorded varied significantly. The 'missings' could be associated with referring physician's background and patients' demographics such as 'age' that should be considered for the improvement of triage quality in the future.

Keywords: Paediatric critical care; Quality; Triage; Vital signs.