Background and aims: Triage systems are widely applied in emergency departments to prioritize patients. A systematic appraisal of the evidence regarding their performance in children is lacking. The aim of this study was to assess the performance of triage systems for identifying high and low urgency children in the emergency department
Methods: We systematically searched five electronic databases from 1980 to 2016. Studies that evaluated an emergency medical triage system, assessed validity using any reference standard as proxy for true patient urgency and were written in English were included. Reviewers identified studies, extracted data, and assessed quality of evidence independently and in duplicate. Raw data were extracted to create 2x2 tables and calculate sensitivity and specificity. ED patient volume and case-mix were investigated as determinants of triage systems’ performance.
Results : Twenty-five eligible studies were conducted in children evaluating nine different triage systems. Only three triage systems had more than one evaluation: Canadian Triage and Acuity Scale, Emergency Severity Index, and Manchester Triage System. A wide range of reference standards was used. Although the number of studies was low, overall validity to identify high and low urgency patients appeared moderate to good, but performance was highly variable. For hospitalisation, the most commonly reported outcome, sensitivity ranged from 0.13 to 0.85 and specificity from 0.70 to 0.96. No clear association was found between ED patient volume or case-mix and triage systems’ performance.
Conclusions: Established triage systems show a reasonable validity for the triage of patients at the ED, but performance varies considerably. Important research questions that remain are what determinants influence triage systems’ performance and how the performance of existing triage systems can be improved.