Pediatric Disaster Triage Emodule for Evaluating and Improving Pediatric Triage Decisions

Background: Pediatric patients have unique needs that are often unaddressed in standard triage exercises. Pediatric disaster triage poses challenges including lack of familiarity with pediatric physiology, children with complex health needs, differing development and psychological states, and heightened emotions. Although initial triage usually occurs at the scene of the event, triage is a dynamic process and occurs at various stages. It is important for clinicians at all levels to be familiar with and apply a standardized disaster triage system. However, there is no standardized curriculum for disaster triage in pediatric training.

Methods: We sought to evaluate and improve the accuracy of triage decisions made by clinicians of various training levels using the SALT (Sort, Assess, Life-Saving Intervention, Treatment/Transport) triage system at our institution through the creation of a pediatric disaster triage eLearning module. The module included a narrated didactic covering the concept of triage, SALT triage algorithm, and pediatric limitations of triage systems. We recruited pediatric emergency medicine attendings and fellows, emergency department-based pediatricians and advanced practice providers, and pediatric residents at a tertiary-care pediatric hospital using departmental email groups.

The investigators created descriptions for twenty fictional triage patients that were used in a pre and post-test triage activity, including infants, medically complex patients, and technology-dependent patients. The investigators reached a consensus on the accurate triage level for each fictional patient.

During the pre and post-test activity, participants triaged 20 fictional pediatric patients to either green, yellow, red, or black categories. To add a realistic level of stress, they had an average of twenty seconds to designate a triage category for each patient. Participants were provided a visual of the SALT triage algorithm during both the pre and post-test triage activity. Non-parametric tests were used to compare median percent accuracy between groups.

Results: There were 41 participants: 23 pediatric emergency medicine attendings (56%), 8 pediatric emergency medicine fellows (19.5%), 9 pediatric residents (22%), 1 physician assistant (2.5%). Approximately half reported previous experience with disaster triage that included simulations, lectures, courses, and experience with real disasters. The median (interquartile range [IQR]) pretest percent accuracy across all participants was 75 (65, 85). Attendings scored higher than residents (80; 73,88 compared to 65; 55,65, p=0.02) but not significantly higher than fellows (75; 70, 84). For the 37 participants who completed both the pre and post-test, median score improved 75 (65, 85) to 80 (75, 85), p=0.03.

Data collection and subgroup analyses are ongoing with plans to expand this offering to include more residents, advanced care practitioners, nurses, and medical students.

Conclusion: There is variation in accuracy of pediatric triage decisions amongst clinicians of different training levels. An eLearning module is a feasible method of providing just-in-time triage training to improve accuracy of triage decisions for pediatric patients.