Pediatric early warning score versus a paediatric triage tool in the emergency department: A reliability study.
Hanne Branes, Anne Lee Solevåg, Marianne Trygg Solberg
PMID 33570310WHAT IT FOUND
In Norwegian paediatric emergency departments, PEWS triage often disagreed with RETTS-p and missed many children RETTS-p classified most urgent.
Nurses should not rely on PEWS alone to identify children needing immediate physician review.
Key findings
01PEWS and RETTS-p gave the same urgency category in only 80 of 200 children.
02Only 7 of 20 children classified red by RETTS-p were also classified red by PEWS.
03When RETTS-p emergency signs and symptoms were excluded, 117 of 200 children received the same triage category, and weighted kappa was 0.50.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in one Norwegian paediatric emergency department, so results may not apply to departments with different patient volumes, tools or experience. The nurse performing PEWS and the nurse performing RETTS-p were not blind to each other's vital signs, and the principal investigator was also a staff member, which may have changed routine assessment. There was no gold standard for true urgency, so agreement could not show which tool was correct. Some months were not observed because the principal investigator was unavailable, which may have selected for certain times or patients. The children and staff knew the study was happening, so routine PEWS scoring may not have been fully normal. Neither PEWS nor RETTS-p was validated for emergency department triage, and RETTS-p had only reliability testing.
Declared interests
The authors declared no conflict of interest. The study was the master thesis of the nurse principal investigator.
The easy way to misread this
Do not conclude that RETTS-p is the correct triage tool or that PEWS is unsuitable for all paediatric emergency care. Neither tool was validated against a true urgency standard, and the study did not measure patient outcomes.