Pediatric triage modifications based on vital signs: a nationwide study

Objective To analyze the clinical significance of a heart rate (HR) or respiratory rate (RR) higher or lower than the normal in pediatric triage. Methods A retrospective observational study was conducted with data from the Korean National Emergency Department Information System. The subjects were children < 15 years of age in 2016. Reported HRs and RRs were divided into seven groups: grade-3 (3 or more standard deviations [SDs] < normal), grade-2 (2 SDs < normal), grade-1 (1 SD< normal), grade 0 (normal), grade 1 (1 SD>normal), grade 2 (2 SDs >normal), and grade 3 (3 or more SDs >normal). The main outcomes were hospitalization and intensive care unit (ICU) admission rates. Logistic regression analysis was used to analyze the relationship of the outcomes according to grade in each group. Results Data for 981,297 patients were analyzed. Hospitalization and ICU admission rates increased significantly in the higher HR group (grades 1 to 3; odds ratio [OR], 1.353; P<0.001; OR, 1.747; P < 0.001; respectively) and in the higher RR group (OR, 1.144; P < 0.001; OR, 1.396; P<0.001; respectively), compared with grade 0 group. In the lower HR group (grades-1 to-3), the hospitalization rate decreased (OR, 0.928; P< 0.001), whereas the ICU admission rate increased (OR, 1.207; P =0.001). Although the hospitalization rate increased. In the lower RR group (OR, 1.016; P=0.008), the ICU admission rate did not increase (OR, 0.973; P=0.338). Conclusion Deviations in HR and RR above normal are related to increased risks of hospitalization and ICU admission. However, this association may not apply to deviations below normal.