26 Predictors of Failure to Measure Vital Signs at Triage in a Pediatric Emergency Department
Bibliographic record
Abstract
Vital signs measurement is considered standard in pediatric emergency department triage assessment but studies have shown a variable incidence of missing data. The aim of this study was to determine clinical and environmental factors associated with missing data for vital signs at triage. A prospective cohort study was conducted in a pediatric tertiary center ED. From November 1st, 2000 to October 31st, 2001, three periods of 8 hours were randomly chosen monthly. During these periods, all patients triaged to the ED were evaluated. Demographic and clinical data were collected by a single investigator not involved in the care of the patients. Nurses and physicians were blinded of the study objective. Univariate and multivariate logistic regression analyses were performed in order to evaluate determinants of missing data for heart rate, respiratory rate, blood pressure, or pulse oximetry. There were 2081 patients triaged and during the study periods. There was a missing data for heart rate for 921 (42%) patients. The missing data rate was of 60% for respiratory rate, of 69% for blood pressure and of 74% for pulse oxymetry. On multivariate logistic regression analysis, independent clinical predictors of missing data for heart rate measurement at triage included: age (per year) OR=0.95 (95% CI: 0.93, 0.96), triage level (from 1=priority to 4=non-urgent) OR=2.11 (95% CI: 1.64, 2.42), being asthmatic OR=0.29 (95% CI: 0.16, 0.52). Shift of presentation was also independently associated with the risk of missing data for heart rate: using night as reference, day shift OR=1.47 (95% CI: 1.06, 2.04) and evening OR=2.89 (95% CI: 2.10, 4.00). Decreased level of consciousness, immunocompromized state, and dependence on a medical device did not meet significance. Results were similar when analysis were repeated for respiratory rate, blood pressure and pulse oximetry. Factors related to patient's clinical characteristics such as age, acuity of triage level and presence of asthma, were associated with a higher rate of vital signs measurement at triage. An environmental factor, shift of presentation, is also independently associated.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.022 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".