EFFECTIVENESS OF THE PEDIATRIC ASSESSMENT TRIANGLE IN IDENTIFYING SICK CHILDREN IN EMERGENCY TRIAGE

Abstract

Background

The number of children presenting to the ED is growing and delays in the evaluation of children who are extremely ill negatively affect patient outcomes. The Pediatric Assessment Triangle (PAT) is a simple, non-technological assessment tool to rapidly assess a sick child, but there is limited evidence from the LMICs.

Objective

To evaluate the diagnostic accuracy of the PAT in predicting hospital admission at a tertiary care hospital in Pakistan.

Methods

A prospective observational study was carried out at the Indus Hospital, Karachi during January – December, 2024. Children aged 0–14 years were consecutively enrolled. The association between Pediatric Assessment Triangle findings (sick vs. not sick) and the hospital admission were evaluated by chi-square test and logistic regression model after controlling for age and gender. The diagnostic accuracy (sensitivity and specificity, predictive values) was computed.

Results

Among 426 children (mean age 4.2 ± 3.9 years; 60.6% male), 143 (33.6%) were classified as sick. Hospital admission was significantly higher in the sick group compared to the not sick group (83.9% vs. 38.5%, p < 0.001). The odds of admission were more than eight times higher in children with abnormal Pediatric Assessment Triangle findings (OR = 8.33, 95% CI: 5.02–13.83). Admission rates increased progressively with higher scores: 38.2% for score 0, 74.5% for score 1, and 100% for scores 2 and 3. The tool demonstrated high specificity (88.3%) and positive predictive value (83.9%), with moderate sensitivity (52.4%). After adjusting for age and gender, abnormal findings remained an independent predictor of admission (adjusted OR = 8.29, 95% CI: 5.00–13.74, p < 0.001).

Conclusion

The PAT is a simple, effective, and independent predictor of hospital admission in pediatric emergency triage supporting its use as an initial screening tool in resource-limited environments.