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The Pediatric Assessment Triangle (PAT) has recently been widely introduced into the pediatric resuscitation curriculum with both contents in hardcopies, softcopies ( such as PDF).
Although logical, its performance attributes remain unmeasurable.
So, using the PAT, the physician observes three components: appearance, breathing work, and skin circulation.
This study aims to evaluate its accuracy, reliability, and validity as used by nurses during triage.
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What is the Pediatric Assessment Triangle
The Pediatric Assessment Triangle (PAT) is a brief assessment tool that determines a child’s clinical condition and disease category to guide prevention and treatment objectives.
What is the Assessment Triangle?
The assessment triangle provides a model which should be used to examine how the different aspects of the child’s life and context interact and impact the child.
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Who Created Pediatric Assessment Triangle?
Dieckmann RA et al. introduced the Pediatric Assessment Triangle (PAT) in 2000, which involves three main elements: appearance, work of breathing, and circulation to the skin.
Methods
Triage nurses administered the PAT to all patients arriving at the pediatric emergency department of an urban teaching hospital in the United States in this prospective observational study.
Results
In total, 524 kids were included in the study. The PAT was used to calculate likelihood ratios (LRs) for instability and pathology categories.
So, children rated stable by initial PAT were nearly ten times more likely to be stable on subsequent evaluation (LR 0.12, 95% CI 0.06-0.25).
The PAT also defined pathophysiology categories, including respiratory distress (LR+ 4, 95% CI 3.1-4.8), respiratory failure (LR+ 12, 95% CI 4.0-37), shock (LR+ 4.2, 95% CI 3.1-5.6), central nervous system/metabolic disorder (LR+ 7, 95% CI 4.3-11), and cardiopulmonary failure (LR+ 49, 95% CI 20-120).
Discussion
The thorough study of the first PAT, as conducted by triage nurses, quickly and accurately identifies high-acuity pediatric patients and their pathophysiology category.
Therefore, the PAT is a good predictor of the child’s clinical state after additional testing.
What is the Purpose of the Pediatric Assessment Triangle?
Triage nurses conduct the PAT on all patients coming to an urban teaching hospital’s pediatric emergency department.
This is for the purposes of prospective observational research.
As a result, the researchers conducted a blind record review, with the physician’s initial evaluation and final diagnosis serving as the criteria standard for comparison.
| Normal Respiratory Rate: Normal Pulse Rate Lower Limit of Normal Systolic BP | ||
| Infant (<1yr): 30- 60 Infant: 100-160 Infant: >60 (or strong pulses | ||
| Toddler (1-3yr): 24 -40 Toddler: 90-150 Toddler: >70 (or strong pulses) | ||
| Preschooler(4-5yr): 22- 34 Preschooler: 80-140 Preschooler: >75 | ||
| School-age(6-12yr): 18 -30 School-age: 70-120 School-age: >80 | ||
| Adolescent(13-18yr): 12 -20 Adolescent: 60-100 Adolescent: >90 | ||
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What are the Components of the Pediatric Assessment Triangle?
It is a quick, global evaluation that uses just visual and audio cues and takes only seconds to complete.
As a result, the PAT consists of three parts:
- Physical appearance
- Work of Breathing
- Circulation Skin
It is the first step in providing answers to three key questions:
- What is the severe condition of the child’s illness or injury?
- Which is the most likely physiologic abnormality?
- How urgent is treatment needed?
The combination of anomalies identified by the three components defines one of six clinical status categories:
- Constant
- Respiratory
- Distress.
- Respiratory failure
- Shock
- CNS/metabolic dysfunction or Cardiopulmonary failure
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Components of the Pediatric Assessment Triangle and the General Impression
| Appearance | Work of breathing | Circulation to skin | |
|---|---|---|---|
| Stable | Normal | Normal | Normal |
| Respiratory distress | Normal | Abnormal | Normal |
| Respiratory failure | Abnormal | Abnormal | Normal |
| Shock | Normal or Abnormal | Normal | Abnormal |
| Central nervous system/metabolic disturbance | Abnormal | Normal | Normal |
| Cardiopulmonary failure | Abnormal | Abnormal | Abnormal |
1]. Physical Appearance (PAT)
The triangle’s “Appearance” section measures a number of variables to determine whether the kid is going through mental status changes (for these can be difficult to pinpoint in an infant or young child).
The “Appearance” item’s elements can also be used to detect whether a child’s airway is clear.
Table 1.
Characteristics of appearance: The ‘Tickles’ (TICLS) Mnemonic
| Characteristic | Normal Features |
|---|---|
| Tone | Moves on its own |
| Resists exam | |
| Sits or stands (age suitable) | |
| Interactiveness | The appearance of alertness and engagement with the physician or caregiver |
| Interacts with others and the environment | |
| Reaches for toys and other stuff (e.g., flashlight) | |
| Consolability | With the caregiver’s holding and consoling, the weeping stops. |
| Has there been a difference in response to caregiver versus examiner? | |
| Look/Gaze | Makes direct eye contact with the service provider |
| Visual tracks | |
| Speech/Cry | Has a powerful cry |
| Makes use of age-appropriate language |
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2]. Work of Breathing (PAT)
The “Work of Breathing” test assesses respiratory effort as well as visible signs of respiratory distress.
To receive an average score on the “Work of Breathing” item, the child’s breathing must be noiseless, easy, and painless.
The youngster should not appear to be struggling to breathe any more than normal.
Table 2.
Characteristics of work of breathing
| Characteristic | Abnormal features |
|---|---|
| Abnormal airway sounds | Snoring |
| Muffled or hoarse speech | |
| Stridor | |
| Grunting | |
| Wheezing | |
| Abnormal positioning | Sniffing position |
| Tripoding | |
| Preference for seated posture | |
| Retractions | Supraclavicular, intercostals, or substernal retractions |
| Head bobbing (infants) | |
| Flaring | Flaring of the nares on inspiration. |
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3]. Characteristics of Circulation to Skin (PAT)
Skin tone and visible bleeding determine “Circulation to Skin.”
Circulation is a good sign of perfusion in children, as measured by skin color and capillary refill.
As a result, an infant with regular circulation will have a normal skin tone.
There will be no noticeable bleeding.
Table 3.
Characteristics of circulation to the skin
| Characteristic | Abnormal features |
|---|---|
| Pallor | Skin or mucous membrane coloring that is white or pale |
| Mottling | Patchy skin discoloration caused by vasoconstriction/vasodilation |
| Cyanosis | Skin and mucous membrane discoloration. |
How Do You Use the Paediatric Assessment Triangle?
Using the pediatric evaluation triangle, the physician observes three components (or ‘arms’ of the triangle): appearance, breathing work, and skin circulation.
In fact, every abnormality found inside a triangle arm classifies the entire component (arm) as abnormal.
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What Does ABC in Pediatric Assessment Triangle Stand For?
In cases of cardiac or respiratory arrest, as well as severe traumatic injuries, unstable Compromised airway, breathing, or circulation is abbreviated as ABC.
What are the Pediatric Circulation Warning Signs?
In cases of cardiac or respiratory arrest, as well as severe traumatic injuries, unstable Compromised Airway, Breathing, or Circulation is abbreviated as ABC.
The pediatric general evaluation triangle’s (PAT) last side evaluates the child’s circulation.
So, the first step is to search for a pale face.
What is the general color of the child?
Therefore, when judging a pale face, keep lighting and the child’s ethnicity in mind.
Is it possible to time the capillary refill?
In fact, the answer is relatively few, but seeing “normal” hundreds of times makes abnormal quite clear.
As a result, it is challenging to develop this testing skill without studying capillary refill in every patient, young and old.
If the child seems pale with an irregular capillary refill, he or she should be checked for mottling and cyanosis.
Finally, mottling is a splotchy discoloration of the limbs that indicate poor perfusion, whereas cyanosis is a blueish discoloration that indicates hypoxia.
Pediatric Assessment Triangle PDF
Conclusion
As demonstrated by a serious adverse probability ratio, the PAT performed well in finding stability in triage.
So, the strength of positive and negative LRs varies between pathophysiological groups, limiting the utility of the PAT alone to rule out an emerging disease.
The PAT can easily identify “red flags” for illness as an alternative to conventional triage techniques, especially when history is absent or restricted.
FAQs
What is the Purpose of the Pediatric Assessment Triangle?
The PAT is a way for fast detecting the child’s alertness, identifying the kind of pathophysiologies, such as respiratory distress, respiratory failure, or shock, and deciding the urgency for treatment.
How do you use the Paediatric Assessment Triangle?
Using the pediatric evaluation triangle, the physician observes three components (or ‘arms’ of the triangle): appearance, breathing work, and skin circulation.
What are the Three Components of the Pediatric Assessment Triangle PAT )?
The three components of the pediatric assessment triangle (PAT) are appearance, work of breathing, and skin circulation.
What does ABC in Pediatric Assessment Triangle Stand for?
In cases of cardiac or respiratory arrest, as well as severe traumatic injuries. Unstable Compromised airway, breathing, or circulation is abbreviated as ABC.
What is the Assessment Triangle?
The assessment triangle in Working Together to Safeguard Children provides a model which should be used to examine how the different aspects of the child’s life and context interact and impact the child.
Who Created Pediatric Assessment Triangle?
Dieckmann RA et al
Frequently Asked Questions About Pediatric Assessment Triangle: Meaning, Application, and Sample PDF
The PAT is a way for fast detecting the child’s alertness, identifying the kind of pathophysiologies, such as respiratory distress, respiratory failure, or shock, and deciding the urgency for treatment.
Using the pediatric evaluation triangle, the physician observes three components (or ‘arms’ of the triangle): appearance, breathing work, and skin circulation.
The three components of the pediatric assessment triangle (PAT) are appearance, work of breathing, and skin circulation.
In cases of cardiac or respiratory arrest, as well as severe traumatic injuries. Unstable Compromised airway, breathing, or circulation is abbreviated as ABC.
The assessment triangle in Working Together to Safeguard Children provides a model which should be used to examine how the different aspects of the child’s life and context interact and impact the child.
Dieckmann RA et al
References
- wikipedia.org– Pediatric assessment triangle
- slideshare.net– Pediatric assessment triangle
- Dieckmann RA, Brownstein D, Gausche-Hill M. The Pediatric Assessment Triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010;26:312–5.[PubMed] [Google S
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