title: Pediatric overtriage as a consequence of the tachycardia responses of children upon ED admission.
abstract: BACKGROUND
  Overtriage has been observed among pediatric patients in emergency departments (EDs) under 5-level acuity pediatric triage systems. This study aimed to investigate the causes of overtriage and to provide suggestions for future amendments to such systems.
  
  
  METHODS
  This study has a retrospective follow-up design in which 42000 pediatric patients who were admitted to the ED of the largest medical center in Taiwan between January and December of 2010 were recruited. The study variables included patient demographics, chief concerns, individual vital signs (ie, blood pressure, heart rate, body temperature, respiratory rate, and O2 saturation), triage level, ED final disposition, ED expenses, and total medical expenses. A logistic regression model was applied to explore the causes of overtriage and the effectiveness of a modified acuity system.
  
  
  RESULTS
  Approximately 13.6% of the pediatric ED visits were upgraded to acuity level 1 based on vital signs that included heart rate (97.3%). The strength of the trend association (odds ratio) between decreasing acuity urgency (from levels 1 to 5) and hospitalization increased from 0.73 (95% confidence interval, 0.72-0.75) with the Pediatric Triage and Acuity System (Ped-TTAS) to 0.57 (95% confidence interval, 0.55-0.59) with the modified Ped-TTAS, which downgraded acuity levels by excluding the weighting of vital signs. Further validation was accomplished by comparing the trend association between decreasing acuity urgency and total medical expenses (Ped-TTAS: β = -0.13; modified Ped-TTAS: β = -0.18).
  
  
  CONCLUSIONS
  Heart rate is prone to be affected by emotional responses among pediatric patients in certain specific age groups. Appropriate revisions of the pediatric triage system are suggested.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Medical Education, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Yu-Che
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. Electronic address: ngowl@ms3.hinet.net.
authors.forename: Chip-Jin
authors.initials: CJ
authors.lastname: Ng
authors.affiliation: Department of Pediatrics, Division of Pediatric General Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Chang-Teng
authors.initials: CT
authors.lastname: Wu
authors.affiliation: Department of Nursing, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Li-Chin
authors.initials: LC
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Jih-Chang
authors.initials: JC
authors.lastname: Chen
authors.affiliation: Laboratory for Epidemiology, Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Tao-Yuan, Taiwan. Electronic address: khsu@mail.cgu.edu.tw.
authors.forename: Kuang-Hung
authors.initials: KH
authors.lastname: Hsu
mesh_terms: D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013610:Tachycardia / Q000628:therapy*; D013624:Taiwan; D014218:Triage / Q000458:organization & administration*; D055986:Vital Signs