Neftaly Pediatric Triage Protocols

1. Introduction

The Neftaly Pediatric Triage Protocols are designed to provide healthcare professionals with a standardized approach for the rapid assessment and prioritization of pediatric patients based on urgency. These protocols ensure timely interventions, minimize risk, and improve patient outcomes.

Purpose:

• Rapid identification of critically ill or injured children.
• Standardization of triage decision-making.
• Appropriate allocation of resources in emergency settings.

Scope:
Applicable to children from neonates (0–28 days) up to adolescents (up to 18 years) presenting to emergency departments, urgent care centers, or primary care facilities.

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2. Triage Categories

Pediatric patients are assigned a triage category based on clinical urgency. The Neftaly system uses a color-coded system:

Category	Color	Response Time	Description
Resuscitation	Red	Immediate (0 min)	Life-threatening, requires immediate intervention (e.g., cardiac arrest, severe respiratory distress)
Emergent	Orange	<10 min	High-risk, severe pain or distress, potentially life-threatening (e.g., severe asthma attack, sepsis)
Urgent	Yellow	<30 min	Moderate illness or injury requiring prompt attention (e.g., moderate dehydration, fracture without neuro compromise)
Less Urgent	Green	<60 min	Mild illness or injury, stable condition (e.g., minor lacerations, mild fever)
Non-Urgent	Blue	>60 min	Routine care or follow-up, not time-sensitive (e.g., mild rash, routine check-ups)

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3. Initial Assessment

The initial triage assessment should include:

1. Primary Survey (ABC Approach):
   • Airway: Check patency, look for obstruction.
   • Breathing: Respiratory rate, oxygen saturation, effort.
   • Circulation: Heart rate, perfusion, capillary refill.
   • Disability: Level of consciousness (AVPU scale: Alert, Voice, Pain, Unresponsive).
   • Exposure: Check for trauma, rashes, or other urgent findings.
2. Vital Signs by Age Group:

Age Group	HR (bpm)	RR (breaths/min)	BP (mmHg)	Temp (°C)
Neonate (0–28d)	100–180	40–60	60–90/30–60	36.5–37.5
Infant (1–12m)	100–160	30–50	70–100/50–65	36.5–37.5
Toddler (1–3y)	90–150	24–40	80–105/55–70	36.5–37.5
Preschool (3–5y)	80–140	22–34	85–110/55–75	36.5–37.5
School Age (6–12y)	70–120	18–30	90–120/60–80	36.5–37.5
Adolescent (13–18y)	60–100	12–20	100–130/65–85	36.5–37.5

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4. Key Triage Considerations

• Pain Assessment: Use age-appropriate scales (FLACC, Wong-Baker FACES, Numeric 0–10).
• Red Flags for Immediate Attention:
  • Severe respiratory distress, apnea, cyanosis
  • Altered consciousness or seizure
  • Shock signs: pallor, weak pulse, prolonged capillary refill
  • Severe dehydration or persistent vomiting
  • High-risk trauma or suspected non-accidental injury
• Special Populations:
  • Premature infants and neonates: higher risk for sepsis
  • Children with chronic illnesses (e.g., cardiac, respiratory, immunodeficiency) require lower threshold for escalation

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5. Triage Decision Flow

1. Rapid visual assessment → assign immediate category if life-threatening.
2. Measure vital signs and complete primary survey.
3. Identify red flags → escalate to Resuscitation (Red) or Emergent (Orange).
4. If no red flags → assign Urgent, Less Urgent, or Non-Urgent based on vitals, symptoms, and history.
5. Document triage category, time, and initial interventions.

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6. Documentation & Communication

• Record: Triage time, category, vitals, presenting complaint, interventions, and reassessment plan.
• Communicate: Ensure handoff to the treating clinician includes all red flags and abnormal findings.
• Reassessment: Every 15–30 minutes for emergent patients or as clinically indicated.

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7. Training & Quality Assurance

• Triage staff must complete pediatric life support and triage training.
• Regular audits and case reviews ensure adherence to protocols and patient safety.
• Simulation exercises are encouraged for high-risk scenarios.

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8. References

• American Academy of Pediatrics (AAP) Pediatric Emergency Care Guidelines
• Pediatric Advanced Life Support (PALS) Guidelines
• Manchester Triage System – Pediatric Modifications
• World Health Organization (WHO) Emergency Triage Assessment and Treatment (ETAT)