Nobuyuki Nosaka1, Takashi Muguruma2, Emily Knaup3, Kohei Tsukahara3, Yuki Enomoto4, Noriyuki Kaku5. 1. Department of Paediatrics Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan. 2. Department of Emergency Medicine School of Medicine Yokohama City University Yokohama Japan. 3. Advanced Emergency and Critical Care Medical Centre Okayama University Hospital Okayama Japan. 4. Department of Emergency and Critical Care Medicine University of Tsukuba Hospital Tsukuba Japan. 5. Emergency and Critical Care Centre Kyushu University Hospital Fukuoka Japan.
Abstract
Aim: The revised Fire Service Law obliges each prefectural government in Japan to establish a prehospital acuity scale. The Foundation for Ambulance Service Development (FASD) created an acuity scale for use as a reference. Our preliminary survey revealed that 32 of 47 prefectures directly applied the FASD scale for children. This scale shows abnormal ranges of heart rate and respiratory rate in young children. This study aimed to evaluate the validity of the abnormal ranges on the FASD scale to assess its overall performance for triage purposes in paediatric patients. Methods: We evaluated the validity of the ranges by comparing published centile charts for these vital signs with records of 1,296 ambulance patients. Results: A large portion of the abnormal ranges on the scale substantially overlapped with the normal centile charts. Triage decisions using the FASD scale of vital signs properly classified 22% (n = 287) of children. The sensitivity and specificity for high urgency were as high as 91% (95% confidence interval, 82-96%) and as low as 18% (95% confidence interval, 16-20%). Conclusion: We found there is room for improvement of the abnormal ranges on the FASD scale.
Aim: The revised Fire Service Law obliges each prefectural government in Japan to establish a prehospital acuity scale. The Foundation for Ambulance Service Development (FASD) created an acuity scale for use as a reference. Our preliminary survey revealed that 32 of 47 prefectures directly applied the FASD scale for children. This scale shows abnormal ranges of heart rate and respiratory rate in young children. This study aimed to evaluate the validity of the abnormal ranges on the FASD scale to assess its overall performance for triage purposes in paediatric patients. Methods: We evaluated the validity of the ranges by comparing published centile charts for these vital signs with records of 1,296 ambulance patients. Results: A large portion of the abnormal ranges on the scale substantially overlapped with the normal centile charts. Triage decisions using the FASD scale of vital signs properly classified 22% (n = 287) of children. The sensitivity and specificity for high urgency were as high as 91% (95% confidence interval, 82-96%) and as low as 18% (95% confidence interval, 16-20%). Conclusion: We found there is room for improvement of the abnormal ranges on the FASD scale.
Authors: Susannah Fleming; Matthew Thompson; Richard Stevens; Carl Heneghan; Annette Plüddemann; Ian Maconochie; Lionel Tarassenko; David Mant Journal: Lancet Date: 2011-03-19 Impact factor: 79.321