Wallis, Lee Alan

2019-02-15T14:25:52Z

2019-02-15T14:25:52Z

2006

Assessment of physiological parameters forms an essential part of the clinical assessment of an injured or ill child. However, the evidence base for the values that we currently accept and teach as "normal" ranges of heart rate and respiratory rate is poor. This thesis studied 1109 healthy, resting schoolchildren aged four to 16 years in Plymouth, England, and derived reference ranges of heart rate and respiratory rate from this sample. A study was then undertaken in a deprived area of Cape Town, South Africa, to examine the heart and respiratory rates of 346 healthy, resting schoolchildren aged five to 16 years. This sample was similar by height and weight to the British sample, and their heart and respiratory rates were compared. There was no difference in median heart rate in the two groups, but a small statistically significant difference in respiratory rate. However, this difference was too small to be clinically significant, being less than one breath per minute. As there were no diferneces in physiology between the two countries, the validation of the Paeditric Triage Tape could take place in South Africa and the results be applied in the United Kingdom. The third stage of this thesis consisted of a Delphi study to derive consensus based criteria against which major incident triage tools may be tested, as the current testing standards (most commonly, the Injury Severity Score (ISS)) are not appropriate for use in a major incident setting. The criteria thus derived were used as part of the validation process for the Paediatric Triage Tape (PTT), a simple to use vinyl tape that is used for primary triage of children in major incident situations. The validation also proceeded against more typical measurement standards, including the The validation took place in Cape Town, against a prospective sample of 3461 injured children. The PTT was found to have very poor sensitivity (that is, it missed many of the seriously injured children and many of the children in need of immediate medical intervention), although it had excellent specificity. The overtriage and undertriage rates were within the limits currently held to be acceptable. The PTT was compared to other major incident triage tools and found to have similar performance to Careflight methodology. Both the START and JumpSTART algorithms performed very poorly and should be discontinued from use. The PTT needs redesigning and revalidating, or replacing by a more robust primary triage tool. In the meantime, all primary triage tools for children in this setting should be used with caution.

http://hdl.handle.net/1842/34335

The University of Edinburgh

Annexe Thesis Digitisation Project 2019 Block 22

Validation of the paediatric triage tape

Thesis or Dissertation

Doctoral