Triage
Emergencies Priority signs Non-urgent (queue) Early recognition of life-threatening emergencies and rapid provision of appropriate care can prevent childhood deaths and reduce associated morbidity. Triage aims to identify those children most in need of resuscitation and emergency care. It involves the rapid examination of all sick children when they first arrive in hospital in order to appr
Early recognition of life-threatening emergencies and rapid provision of appropriate care can prevent childhood deaths and reduce associated morbidity.
Triage aims to identify those children most in need of resuscitation and emergency care. It involves the rapid examination of all sick children when they first arrive in hospital in order to appropriately prioritise their care. They should be reassessed regularly while awaiting definitive care.
1. Emergencies: Conditions that cannot wait and require immediate treatment.
2. Priority signs: (place ahead of the normal queue).
3. Non-urgent: (join the queue).
EMERGENCIES
Conditions that cannot wait and require immediate treatment
If any emergency sign is present: give emergency treatment, call for help, and perform relevant emergency laboratory investigations.
(A&B) Airway and breathing
- Not breathing
or
- Airway obstructed
or
- Central cyanosis
or
- Severe respiratory distress
(C) Circulation
- Cold hands
and
- Capillary refill ≥3 seconds
and
- Weak and fast pulse
(C) Coma/convulsing
- Coma
or
- Convulsing (at the time of evaluation)
(D) Severe dehydration
Fluid loss plus any two of the following:
- Lethargy
- Sunken eyes
- Very slow skin pinch (the fold is visible for more than 2 seconds)
PRIORITY SIGNS (Place ahead of the normal queue)
These children need prompt assessment and treatment:
- young infant (< 3 months),
- temperature very high (> 38ºC) or very low (<36.4ºC),
- trauma or other urgent surgical condition,
- severe pallor,
- history of poisoning,
- severe pain,
- respiratory distress,
- restless, continuously irritable, or lethargic,
- urgent referral from another health professional,
- malnutrition: visible severe wasting,
- oedema of both feet,
- burns (major).
NON-URGENT (Queue)
Proceed with assessment and further treatment according to the child’s priority.
A number of different triage processes exist and the above is based on the South African Emergency Triage Assessment and Treatment (ETAT).
In addition, the use of clinical markers such as respiratory rate, blood pressure and pulse rate add precision to triage.
Other important conditions may be added to the ETAT guidelines based on local circumstances, such as identifying infectious diseases that need immediate isolation, dehydration (not severe), facial or inhalational burns, evidence of meningococcal septicaemia, and inconsolable crying.
The ETAT triage presented above should be a minimum standard of triage in community health centres, district or regional hospitals in South Africa.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 1: Emergencies and Trauma, 1.1 Paediatric Emergencies, 1.1.1 Triage