Revisions to the Canadian Triage and Acuity Scale paediatric guidelines (PaedCTAS).

The need for effective triage of the increasing number of patients presenting for emergency care was recognized in the early 1990s. Dr. Robert Beveridge led the development of a Canadian triage scale based on work done in Australia to create the Australasian National Triage Scale. The original Canadian Emergency Department Triage and Acuity Scale (CTAS) was an adult-centred classification that provided guidelines as to what presentations would fit in a given triage level. It included both presenting complaints and discharge diagnoses. This scale was incomplete in that only sentinel conditions were considered on diagnosis. Review of childhood deaths of patients awaiting care in emergency departments in Ontario (1994) identified the problem with defining triage by presenting diagnosis alone. In response to this review, the Canadian Triage and Acuity Scale Paediatric Guidelines (PaedCTAS) was created to include physiologic assessment as an essential component of triage in children. In 2001, a paediatric version was published, one that was more inclusive of common paediatric presentations and physiologic parameters. Studies have shown PaedCTAS to have moderate to good interrater agreement between nurses evaluating children, and good validity demonstrated by the correlation between triage level and markers of severity. Throughout this article “children” includes newborns, infants, children and adolescents. Early in the development of CTAS and PaedCTAS, the National Working Group (NWG) recognized the challenge of basing triage on final ICD-10 diagnosis. Both adults and children present with symptoms and concerns that, depending on their past experiences and apprehensions, may not immediately identify the current medical problem. In 2004, the NWG reorganized CTAS based on presenting complaints (CEDIS; Canadian Emergency Department Information System Presenting Complaint List). Health care delivery and patient expectations continue to evolve, which requires ongoing evaluation of the CTAS process. Changes to hospital and emergency department accountability have included the development of electronic triage systems. CTAS and PaedCTAS have been revised to meet these demands (Table 1). The current version (2008) is a unified adult and paediatric triage process based on presenting complaints, with physiologic and historical modifiers. This article will highlight the most recent changes concerning paediatric triage assessment and should be used in conjunction with the previous adult guidelines article.