Effectiveness of telephone triage system in a Pediatric emergency service

Abstract

Aim: To evaluate the effectiveness of the telephone triage system Saúde 24 Pediatria in the paediatric emergency service (ES) of S. Francisco Xavier Hospital (HSFX), Lisbon, Portugal. Methods: Children 0-14 year old that used the paediatric ES of HSFX in the period between October 1st 2001 and January 31st 2002 were included in a case control study. Cases (n=106) included all the children referred during that period to the ES; controls (n=106) were children paired up by age and week of observation in ES. Two paediatricians had reviewed both cases and controls. Results: Nine pairs were excluded; the final convenience sample consisted of 194 individuals. Males and age groups of 2-6 and 1-2 years predominated; significantly more children in the control group (59%) than in the case group (43%) came to the hospital ES without a valuable clinical reason. The most frequent diagnosis was upper respiratory tract infection (URTI). Comparing the final diagnosis and the adequacy of ESs use in the two groups, the controls with URTI and gastrointestinal disease seemed to use 5 times more the ES on a unjustified way than the cases. Saúde 24 line seemed to be equally sensitive to the adequacy of referral of lower respiratory tract infection, but without difference for the controls. Conclusions: System Saúde 24 seems to contribute to relieve the pressure in paediatric ES, as it refers only a small proportion of the children that contact it. However, many of the referred children do not present disease that justifies an observation in the hospital, reflecting the limitations of any triage system based on subjective data supplied by the parents.