A difficult balance has to be achieved between undertriage
, where patients likely to substantially benefit from ICU admission are not afforded this opportunity, leading to adverse outcomes, and overtriage, where patients who are unlikely to benefit from intensive care are admitted, resulting in an inappropriate utilisation of resources.
The evidence on the validity of pediatric triage systems remains insufficient, and there has been concern about the level of undertriage in several studies .
Validity parameters included sensitivity, specificity, positive and negative predictive value, and associated percentages for over- and undertriage. Sensitivity was the ability of the triage to correctly identify the patients that needed hospitalization, and, thus, the proportion of patient with a high triage priority among those admitted.
The sensitivity was increasing and the undertriage was decreasing for the children less than 4 years of age.
found an undertriage of 22 %, an overtriage of 29 %, and a corresponding sensitivity of 78 % for the pediatric subgroup, using hospitalization as primary outcome .
Ideally, a triage system should have no or minimal over- and undertriage. Overtriage will have minimal adverse consequences for the patients but may cause interruptions and can possibly wear out health care providers working in the ED.
The high level of undertriage in our study may have several reasons.
Another limitation to this study is the lack of system for recording adverse events as consequences of over- and undertriage. We did not gather information on return to ED or whether the patients were treated in the primary health care after leaving the ED.
The level of undertriage was relatively high and of concern but may partly be related to national routines of referral and prehospital treatment.
American College of Surgeons (ACS) secondary trauma triage guidelines state that a 10% undertriage
rate is acceptable and a 50% overtriage or false-positive rate is unavoidable in order to capture as many at-risk patients as possible, Dr.