A Delphi process to determine clinicians’ attitudes and beliefs towards paediatric major incident triage within the United Kingdom
Authors: Vassallo J , Blakey S , Cowburn P , Surridge J , Smith JE , Scholefield B , Lyttle Mark D 
Published: February 2022

Introduction

Triage is a key principle in the effective management of major incidents, yet there is a paucity of evidence surrounding the optimal method of paediatric major incident triage (MIT). This study aimed to derive consensus on key components of paediatric MIT among healthcare professionals involved in the management of paediatric major incidents.

Methods

This modified two-round online Delphi consensus study, delivered between July and October 2021, included participants from pre-hospital and hospital specialities involved in managing a paediatric major incident. Statements were derived iteratively based on review of MIT tools, and extant literature. A 5-point Likert agreement scale was used to determine consensus, which was set a priori at 70%.

Results

111 clinicians completed both rounds, with 13 of 17 statements reaching consensus. Positive consensus was reached on the use of rescue breaths in mechanisms associated with hypoxia or asphyxiation, use of mobility assessment as a crude discriminator of injury, and use of adult physiology for older children. Whilst positive consensus was reached on the benefits of a single MIT tool for use across the entire adult and paediatric age range, there was negative consensus in relation to the clinical implementation of such a tool. Consensus could not be reached regarding the use of a single tool across the whole paediatric age range specifically, nor on the use of rescue breaths in blunt or penetrating trauma.

Conclusion

This Delphi study has established consensus among a large group of subject matter experts on several key elements of paediatric MIT. Further work is required to develop a triage tool that can be implemented based on emerging and ongoing research, and which is acceptable to clinicians.

What this paper adds?

Section 1: What is already known on this subject?

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Whilst triage is a key principle in the effective management of a major incident, there is limited evidence surrounding the use of existing paediatric major incident triage (MIT) tools

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Paediatric MIT tools currently used in the UK are associated with high rates of under-triage, failing to identify those in need of life-saving interventions

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Existing paediatric MIT tools differ from adult tools, including approach to physiological ranges, and recommendation for initiation of rescue breaths

Section 2: What this study adds

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Consensus was reached supporting use of rescue breaths for mechanisms associated with hypoxia or asphyxiation, mobility as a crude discriminator for serious injury, and adult physiology for older children

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Whilst consensus was reached on benefits related to use of a single tool across all age ranges (adult and paediatric), the expert panel did not support this approach for actual clinical practice

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There was no consensus on use of rescue breaths in blunt or penetrating trauma, or use of a single triage tool for the entire paediatric age group

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Further work is required to develop and implement a MIT tool that accurately identifies children needing life-saving interventions, and that is acceptable to clinicians