| Objective:To evaluate the effectiveness and the feasibility of pediatric assessment triangle(PAT),by comparing with the pediatric early warning score(PEWS)which is usually applied at clinical setting currently and find out a simpler and more effective scientific tool which can screen out critical ill children quickly for emergency preview triage nurse.Method:The convenience sampling method was adopted to select the children who visited the emergency department of a tertiary general hospital in Jiangsu province from January 2019 to May 2019 as the research objects for this prospective investigation.During emergency preview and triage for children in the first time at emergency room,two trained professionals use PAT and PEWS respectively at the same time to evaluate the children with severe degree or not,then record with temperature,history of past and current medical history on admission,and follow up with the illness severity for all children,especially for critical children.Using the area under the receiver operating charateristic curve(AUROCC),sensitivity,specificity,the Yorden index,the effectiveness of PAT and PEWS in assessment the severity of children’s disease were analyzed and compared.Under different thresholds of PAT score,the sensitivities,specificities and the Yorden indexes of PAT in assessing critical children were analyzed,to obtain the optimal PAT score.By comparing the times for PAT and PEWS assessment and the acceptances of trained professionals to PAT and PEWS by visual analogue scale(VAS)and questionnaire survey,the feasibility of PAT was evaluated.Results:1.Among 1.636 study subjects,a total of 1.608 children met the inclusion criteria,including897 males and 711 females were included in the analysis.55.78%were male and 44.22%were female.The age ranged from 1 month to 14 years.Children were divided into the critical group(74 cases.4.60%)and the non-critical group(1534 cases.95.40%)according to whether the medical records were prescribed or not.2.The AUROCC to screen out the critical children evaluated by PAT was 0.963.When the threshold of PAT score was 1,its sensitivity,specificity,PPV and NPV were 93.24%,99.15%,84.15%and 99.67%,respectively.The maximum value of the Youdon index of PAT scored with 1 was 0.924.3.The AUROCC,the sensitivity,specificity,PPV,NPV and Youden index of the PAT to predict the severity of the illness were 0.963,93.24%,99.15%,84.15%,99.67%,and 0.924,respectively.The AUROCC,sensitivity,specificity,PPV,NPV and Youden index of the PEWS were 0.966,91.89%,98.63%,76.40%,99.61%and 0.906,respectively.Comparing the AUROCC,the sensitivity and specificity index of PAT and PEWS,there were no statistically significant differences(P>0.05).4.The assessment time of PAT was 13.81± 6.41 seconds,while PEWS score was 37.24± 10.29 seconds,significantly longer than PAT’s with statistically significant difference(t=17.27,P<0.05).A total of 30 nurses in the outpatient and emergency pre-examination triage were surveyed to obtain the nurses’ acceptance of PAT.The result showed that nurses’ acceptance of PAT was significantly higher than that of PEWS,with a statistically significant difference(t=2.50,P<0.05).The nurses believed that both assessment tools were based on observing the children’s consciousness,breathing and circulation to assess their condition,they can quickly and accurately identify children in need of urgent treatment or priority treatment,and have great benefit for pre-screening triage.But compared to PEWS,when nurses used PAT to assess children’s condition,they do not need any medical device settings to identify the severity of children’s condition,only using visual and auditory,even did not measure heart rate and breathing of children.When there are many children in the waiting area for inspection and triage,nurses preferred PAT for evaluation because it could preferentially and accurately screen critically ill children who need urgent treatment.Conclusion:PAT can be used as a rapid and effective assessment tool in emergency medicine.When a child’s PAT score is 1 or more,the child’s condition is serious and should be treated urgently. |
