CHAPTER ■ A GENERAL APPROACH TO TRIAGE DEBRA A POTTS, MARY KATE F ABBADESSA, SHANNON M GAINES INTRODUCTION Children are cared for in all emergency departments (EDs) from general EDs that see primarily adult patients, to those general EDs with a separate pediatric section, to pediatric EDs that exist within a pediatric institution In the last two decades there has been a considerable increase in ED visits in the United States, almost a fourth of these visits are by children In 2015, there were 30 million ED visits for children less than 18 years of age As the health burden on emergency services continues to rise, it is critical to have a reliable method of triaging children presenting for services HISTORY OF TRIAGE The term “triage” derived from the French word “trier,” to sort, was first used back in the 18th century to document the severity of injury in warfare Battlefield triage eventually made its way into the American medical system and in 1964 Wasserman et al published the first use of civilian triage in EDs Subsequently many institutions, federal agencies, and emergency medical systems have continued to study and refine triage systems in the United States CURRENT TRIAGE SYSTEMS Pediatric triage requires rapid assessment of those presenting to the ED including determination of severity of illness or injury, assignment of acuity level, and anticipation of appropriate emergency care resources needed With limited resources available, the goal of the triage process is “right patient, right provider, right care, right time,” which demands a standardized approach The American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA) have recommended that EDs use a reliable and valid fivelevel triage system for prioritizing the care of children presenting to the ED In 2010, the ACEP and ENA, based on expert consensus of currently available evidence, supported the adoption of a reliable, valid five-level triage system such as the Emergency Severity Index (ESI) Following the release of this position statement, the number of EDs using the five-level ESI triage system increased significantly