title: The Validity of the Pediatric Assessment Triangle as the First Step in the Triage Process in a Pediatric Emergency Department.
abstract: OBJECTIVE
  This study aimed to assess the association between pediatric assessment triangle (PAT) findings during triage and markers of severity in a pediatric emergency department (PED).
  
  
  METHODS
  During the study period, patients arriving to the PED were classified by trained nurses with the Pediatric Canadian Triage and Acuity Scale using a computer system, from which data were obtained and analyzed retrospectively. The primary outcome measure was the percentage of children hospitalized related with PAT findings. The secondary outcome measures were the admission to the intensive care unit (%), PED length of stay, and performance of blood tests (%).
  
  
  RESULTS
  Among the 302,103 episodes included, there were abnormal PAT findings in 24,120 cases (7.9%). Multivariate analysis adjusted for age confirmed that PAT findings and triage level were independent risk factors for admission (odds ratio [OR], 2.21; 95% confidence interval [CI], 2.13-2.29; OR, 6.01; 95% CI, 5.79-6.24, respectively). Abnormal findings in appearance or in more than 1 PAT component were even more strongly associated with admission (3.99; 95% CI, 3.63-4.38; 14.99, 95% CI, 11.99-18.74, respectively). When adjusted for triage level and age, abnormal PAT findings were also an independent risk factor for intensive care unit admission (OR, 4.44; 95% CI, 3.77-5.24) and a longer stay in the PED (OR, 1.78; 95% CI, 1.72-1.84).
  
  
  CONCLUSIONS
  Abnormal findings in the PAT applied by trained nurses at triage identify patients with a higher risk of hospitalization. The PAT seems to be a valid tool for identifying the most severe patients as a first step in the triage process.
authors.affiliation: From the *Pediatric Emergency Department, and †Epidemiology Unit, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Ares
authors.forename: Sara
authors.initials: S
authors.lastname: Garcia
authors.forename: Lorea
authors.initials: L
authors.lastname: Martinez-Indart
authors.forename: Santiago
authors.initials: S
authors.lastname: Mintegi
authors.forename: Javier
authors.initials: J
authors.lastname: Benito
mesh_terms: D002170:Canada; D002648:Child; D002675:Child, Preschool; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D009730:Nursing Assessment / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000379:methods*; D012189:Retrospective Studies; D014218:Triage / Q000379:methods*