Reproducibility of the TRIPED-GM paediatric triage system.

Abstract

Introduction: The triage system aims to determine the level of urgency of patients in order to provide appropriate care and reduce morbidity and mortality. It is essential that the system used is valid, reliable and easy to use. The TRIPED-GM system is a five-level classification system exclusively for pediatric age, which includes six steps, three of which are mandatory (PAT, guiding sign/symptom, and priority rectifiers).

Objective: To determine the reproducibility of the TRIPED-GM system when used on patients evaluated consecutively by 2 nurses.

Method: Observational, descriptive, cross-sectional study involving 237 patients under 16 years of age who attended a third-level pediatric emergency service. Reliability was measured using Kappa (κ), linear Kappa (κp), and quadratic Kappa (κp²) indices, which compared the priority assigned by two research nurses and sixteen paediatric emergency nurses with over a year of experience in triage. Patients were classified consecutively and blindly.

Results: There was agreement in 221 (93.2%) patients. The overall concordance was: κ = 0.84 (95% CI 0.77-0.91), κp = 0.85 (95% CI 0.78-0.92), κp² = 0.85 (95% CI 0.78-0.92). There were no differences in the assignment of more than one priority level in any patient. Concordance in the mandatory steps was: Pediatric Assessment Triangle: κ = 0.82 (95% CI 0.68-0.96), Main reason for consultation: κ = 0.76 (95% CI 0.62-0.89), Rectifiers: κ = 0.94 (95% CI 0.88-1). Concordance was higher in patients who consulted for illness compared to those for trauma/accidents: κ = 0.84 (95% CI 0.76-0.92) vs. κ = 0.79 (95% CI 0.57-1).

Conclusion: The TRIPED-GM pediatric triage system is reliable for use in emergency services with patients of similar characteristics.