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Triage of Children at the Emergency Department: Manchester Triage System or Pediatric Early Warning Score?

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ClinicalTrials.gov Identifier: NCT02094404
Recruitment Status : Completed
First Posted : March 21, 2014
Last Update Posted : May 29, 2015
Sponsor:
Information provided by (Responsible Party):
E.P. de Groot, Isala

Brief Summary:

Currently, the Manchester Triage System (MTS) is used to triage all children presenting at the emergency department(ED) in this hospital. This system has been proven safe, but many patients are classified as too urgent. In this hospital adults are prioritised at the ED by a score based on vital signs, the early warning score. A similar score is developed suitable for children. This score, the Pediatric Early Warning Score (PEWS), is already used to determine clinical deterioration.

The investigators hypothesize that children can be triaged safely with the PEWS.

If it is safe, there will be one triage system again at the ED. Another advantage will be more continuity in assessing the condition of patients who are admitted to the hospital.


Condition or disease
Triage of Children

Detailed Description:

Background: Triage systems are used at EDs to prioritize patients to make sure that those who need it, receive immediate care.

The MTS is used for children at EDs by many hospitals worldwide, also at the ED of the Isala, the Netherlands. This triage system has been proven safe, but many patients are classified as too urgent. This is a disadvantage because accurate triage is needed to provide access for immediate ill patients and for sufficient flow at the ED.

Currently, adult patients at the ED of the Isala are classified by the early warning score. This is a score based on vital signs and it is easily calculated. It originally has been developed to determine clinical deterioration. For children normal values are different for each age. Therefore there has been developed the PEWS, which is now only used to evaluate clinical patients. Ideally for the continuity in this hospital, there would be one system which can be used for triage as well as for clinical patients. The investigators hypothesize that the PEWS is a safe alternative for the triage of children at the ED.

Design: A form will be attached on the file of all children presenting at the ED, for recording data. These forms will be collected afterwards. The emergency department nurses will record the vital signs, which the investigators need to calculate the PEWS as well as the urgency determined by the MTS for each patient. The expert opinion will also be recorded. This is de urgency according to the doctor who has seen the patient, maximal acceptable door-to-doctor time: very urgent (immediate), urgent (<15minutes) or normal (<1hour). At the end of the consultation at the ED, the reference standard will be determined for each patient independent of MTS urgency or PEWS, with data available from the patient file. (1) For secondary outcome measures may or may not hospital admission or intensive care admission will be recorded.

No interventions are made and this study is of no influence on the treatment of the patients.

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Study Type : Observational
Actual Enrollment : 727 participants
Time Perspective: Prospective
Official Title: Triage of Children at the Emergency Department: Manchester Triage System or Pediatric Early Warning Score?
Study Start Date : December 2013
Actual Primary Completion Date : March 2014
Actual Study Completion Date : March 2014

Group/Cohort
Children at the ED<18yr



Primary Outcome Measures :
  1. Reference standard [ Time Frame: <1day ]

    A reference standard as developed by van Veen et al with 5 urgency levels to be determined with the information available from the patient file as documented after presentation at the ED.

    The reference standard will be separately compared to the MTS as well as the PEWS as determined for each patient presenting at the ED.



Secondary Outcome Measures :
  1. Hospital admission [ Time Frame: <12 hours ]

    Hospital or intensive care admission directly following visiting the ED or to the utmost <12h.

    Admission: yes/no.



Other Outcome Measures:
  1. Expert opinion [ Time Frame: <10 minutes ]
    Assessed directly at the first contact with the patient at the ED by the pediatrician. Maximal acceptable door-to-doctor time: very urgent (immediate), urgent (<15minutes) or normal (<1hour).



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Ages Eligible for Study:   up to 18 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
- All children presenting at the emergency department of the Isala, Zwolle.
Criteria

Inclusion Criteria:

  • All children presenting at the Emergency Department of the Isala.

Exclusion Criteria:

  • Children seen in room 17, the plaster and little trauma room (because of practical reasons).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02094404


Locations
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Netherlands
Isala
Zwolle, Overijssel, Netherlands, 8025 AB
Sponsors and Collaborators
E.P. de Groot
Investigators
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Principal Investigator: E.P de Groot, MD Isala
Publications:
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Responsible Party: E.P. de Groot, MD, Isala
ClinicalTrials.gov Identifier: NCT02094404    
Other Study ID Numbers: KSEH13
First Posted: March 21, 2014    Key Record Dates
Last Update Posted: May 29, 2015
Last Verified: May 2015
Keywords provided by E.P. de Groot, Isala:
Emergency Department
Pediatric Early Warning Score
Manchester Triage System
Additional relevant MeSH terms:
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Emergencies
Disease Attributes
Pathologic Processes