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Pediatric Disposition Classification (Reverse Triage) System to Create Surge Capacity

Published online by Cambridge University Press:  27 March 2015

Gabor D. Kelen ,
Lauren Sauer ,
Eben Clattenburg ,
Mithya Lewis-Newby  and
James Fackler
Gabor D. Kelen*
Affiliation:
The Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland the Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins Institutions, Baltimore, Maryland the National Center for the Study of Preparedness and Catastrophic Event Response, The Johns Hopkins University, Baltimore, Maryland
Lauren Sauer
Affiliation:
The Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland the Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins Institutions, Baltimore, Maryland the National Center for the Study of Preparedness and Catastrophic Event Response, The Johns Hopkins University, Baltimore, Maryland
Eben Clattenburg
Affiliation:
The Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland the National Center for the Study of Preparedness and Catastrophic Event Response, The Johns Hopkins University, Baltimore, Maryland
Mithya Lewis-Newby
Affiliation:
the Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
James Fackler
Affiliation:
the Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Correspondence and reprint requests to G.D. Kelen, MD, FRCP(C), FACEP, Director, National Center for the Study of Preparedness and Catastrophic Event Response, 5801 Smith Ave, Suite 3220, Davis Bldg, Baltimore, MD 21209 (e-mail: [email protected]).
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Abstract

Background

Critically insufficient pediatric hospital capacity may develop during a disaster or surge event. Research is lacking on the creation of pediatric surge capacity. A system of “reverse triage,” with early discharge of hospitalized patients, has been developed for adults and shows great potential but is unexplored in pediatrics.

Methods

We conducted an evidence-based modified-Delphi consensus process with 25 expert panelists to derive a disposition classification system for pediatric inpatients on the basis of risk tolerance for a consequential medical event (CME). For potential validation, critical interventions (CIs) were derived and ranked by using a Likert scale to indicate CME risk should the CI be withdrawn or withheld for early disposition.

Results

Panelists unanimously agreed on a 5-category risk-based disposition classification system. The panelists established upper limit (mean) CME risk for each category as <2% (interquartile range [IQR]: 1–2%); 7% (5–10%), 18% (10–20%), 46% (20–65%), and 72% (50–90%), respectively. Panelists identified 25 CIs with varying degrees of CME likelihood if withdrawn or withheld. Of these, 40% were ranked high risk (Likert scale mean ≥7) and 32% were ranked modest risk (≤3).

Conclusions

The classification system has potential for an ethically acceptable risk-based taxonomy for pediatric inpatient reverse triage, including identification of those deemed safe for early discharge during surge events. (Disaster Med Public Health Preparedness. 2015;9:283-290)

Keywords

surge capacitydisaster planninghealth care rationinghospital bed capacityrisk assessment
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 9 , Issue 3 , June 2015 , pp. 283 - 290
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

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