Assessment of the Value of the PAT as the First Step in the Triage Process in a Pediatric Emergency Room

Abstract

Background: This study aimed to examine the correlation between the pediatric assessment triangle (PAT) and the rate of hospitalization among pediatric patients. Patients presenting to the pediatric emergency department were categorized based on PAT criteria during the study period, and retrospective data analysis was conducted. The primary outcome measure was the percentage of patients with PAT findings who required hospital admission; however, the secondary outcome measure focused on the association between PAT findings and admission to the pediatric intensive care unit (PICU) and the comparison between hospitalization rates with disrupted PAT versus blood testing as the initial diagnostic step. Methods: In this study, 622 patients were enrolled, and among them, 246 patients (39.5%) had normal findings in the peripheral arterial tonometry (PAT) test. The researchers conducted both univariate and multivariate analyses to investigate the relationship between PAT results and hospitalization. They also examined the association between hospitalization and abnormal findings in more than one component of PAT, presentation at the emergency department, performance of blood tests showing abnormalities in more than one component, and appearance while accounting for potential confounding factors. By adjusting for these confounders, the researchers aimed to assess the independent impact of PAT on hospitalization risk and identify any significant associations. Results: The study revealed a strong association between impaired PAT findings and hospitalization, both in univariate and multivariate analyses. Abnormal findings in >1 component of PAT, appearance in the emergency department, and abnormal findings in >1 component of blood tests were the most significant factors related to hospitalization, even after adjusting for confounders. Conversely, normal PAT findings showed no association with either the primary or secondary outcomes. Furthermore, hospitalization rates differed significantly between patients with impaired PAT and those with normal PAT. Conclusions: Impaired PAT findings, when utilized by pediatricians, are associated with increased hospitalization rates, even during the peak of the coronavirus disease 2019 (COVID-19) pandemic. Moreover, it is crucial to emphasize physician training in utilizing PAT effectively as the initial step in evaluating pediatric patients in the emergency room, potentially reducing the need for additional costly testing and enabling physicians to make more confident decisions.