The Irish Children's Triage System is used to triage pediatric patient coming to the Emergency Department.
Patient selection: overdose or poisoning
Shared parameters:
(1) abnormal age-related vital signs
(2) shock
(3) Glasgow coma scale
(4) substance use
(5) pain
(6) blood glucose
(7) duration
(8) history
|
Parameters |
Findings |
Category |
|
abnormal vital signs |
category 1 |
1 |
|
|
category 2 |
2 |
|
|
category 3 |
3 |
|
shock |
uncompensated |
1 |
|
|
compensated |
2 |
|
|
none |
5 |
|
Glasgow coma scale |
<= 12 |
1 |
|
|
13 or 14 |
2 |
|
|
15 |
5 |
|
substance use |
high toxicity |
2 |
|
|
moderate toxicity |
3 |
|
|
low toxicity |
4 |
|
|
none |
5 |
|
pain |
severe (VAS >= 7) |
2 |
|
|
moderate (VAS 4-6) |
3 |
|
|
mild (1 to 3) |
4 |
|
|
none |
5 |
|
blood glucose |
<= 2.7 mmolo/L (hypoglycemia) |
2 |
|
|
2.8 to 3.4 mmol/L |
3 |
|
|
> 3.4 mmol/L |
5 |
|
duration |
less than 48 hours (recent) or acute symptoms |
4 |
|
|
> 48 hours without acute symptoms |
5 |
|
history or mechanism |
significant |
2 |
|
|
inconsistent with findings |
3 |
|
|
consistent |
5 |
where:
• Hyperglycemia is not covered but diabetic ketoacidosis can be triggered by poisoning.
|
Other Parameters |
Category |
|
airway compromise |
1 |
|
respiratory failure/arrest |
1 |
|
currently seizing |
1 |
|
ingestion of unknown substance |
2 |
|
ingestion of multiple substances |
2 |
|
intentional self-harm |
2 |
|
altered work of breathing (increase or decrease) |
2 |
|
cardiac arrhythmia |
2 |
|
altered blood pressure (hyper or hypotension) |
2 |
|
persistent vomiting |
3 |
The final triage category is MIN(triage category for all of the parameters).
If the there was intentional self-harm, then triage for psychosocial problems should be performed.
Specialty: Pedatrics
