title: Pediatric Disposition Classification (Reverse Triage) System to Create Surge Capacity.
abstract: BACKGROUND
  Critically insufficient pediatric hospital capacity may develop during a disaster or surge event. Research is lacking on the creation of pediatric surge capacity. A system of "reverse triage," with early discharge of hospitalized patients, has been developed for adults and shows great potential but is unexplored in pediatrics.
  
  
  METHODS
  We conducted an evidence-based modified-Delphi consensus process with 25 expert panelists to derive a disposition classification system for pediatric inpatients on the basis of risk tolerance for a consequential medical event (CME). For potential validation, critical interventions (CIs) were derived and ranked by using a Likert scale to indicate CME risk should the CI be withdrawn or withheld for early disposition.
  
  
  RESULTS
  Panelists unanimously agreed on a 5-category risk-based disposition classification system. The panelists established upper limit (mean) CME risk for each category as <2% (interquartile range [IQR]: 1-2%); 7% (5-10%), 18% (10-20%), 46% (20-65%), and 72% (50-90%), respectively. Panelists identified 25 CIs with varying degrees of CME likelihood if withdrawn or withheld. Of these, 40% were ranked high risk (Likert scale mean ≥7) and 32% were ranked modest risk (≤3).
  
  
  CONCLUSIONS
  The classification system has potential for an ethically acceptable risk-based taxonomy for pediatric inpatient reverse triage, including identification of those deemed safe for early discharge during surge events.
authors: The Department of Emergency Medicine,The Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors: Gabor D
authors: GD
authors: Kelen
authors: The Department of Emergency Medicine,The Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors: Lauren
authors: L
authors: Sauer
authors: The Department of Emergency Medicine,The Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors: Eben
authors: E
authors: Clattenburg
authors: the Department of Pediatrics,University of Washington School of Medicine,Seattle,Washington.
authors: Mithya
authors: M
authors: Lewis-Newby
authors: the Department of Pediatrics,The Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors: James
authors: J
authors: Fackler
mesh_terms: D002648:Child; D002675:Child, Preschool; D004190:Disasters; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients / Q000145:classification; D010351:Patient Discharge; D055872:Surge Capacity; D014218:Triage / Q000379:methods*
keywords: disaster planning; health care rationing; hospital bed capacity; risk assessment; surge capacity