Abstract
Background Critically insufficient pediatric hospital capacity may develop during a disaster or surge event. Research is lacking on the creation of pediatric surge capacity. A system of reverse triage, with early discharge of hospitalized patients, has been developed for adults and shows great potential but is unexplored in pediatrics. Methods We conducted an evidence-based modified-Delphi consensus process with 25 expert panelists to derive a disposition classification system for pediatric inpatients on the basis of risk tolerance for a consequential medical event (CME). For potential validation, critical interventions (CIs) were derived and ranked by using a Likert scale to indicate CME risk should the CI be withdrawn or withheld for early disposition. Results Panelists unanimously agreed on a 5-category risk-based disposition classification system. The panelists established upper limit (mean) CME risk for each category as <2% (interquartile range [IQR]: 1-2%); 7% (5-10%), 18% (10-20%), 46% (20-65%), and 72% (50-90%), respectively. Panelists identified 25 CIs with varying degrees of CME likelihood if withdrawn or withheld. Of these, 40% were ranked high risk (Likert scale mean ≥7) and 32% were ranked modest risk (≤3). Conclusions The classification system has potential for an ethically acceptable risk-based taxonomy for pediatric inpatient reverse triage, including identification of those deemed safe for early discharge during surge events.
Original language | English (US) |
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Pages (from-to) | 283-290 |
Number of pages | 8 |
Journal | Disaster medicine and public health preparedness |
Volume | 9 |
Issue number | 3 |
DOIs | |
State | Published - Mar 17 2015 |
Keywords
- disaster planning
- health care rationing
- hospital bed capacity
- risk assessment
- surge capacity
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health