Vital Signs

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Do observations of vital signs really indicate how sick a child is? - Would this be an effective triage tool?

Introduction
This assignment will look at papers that are relevant to the research question posed; it will consider their validity, scope of relevance and whether further research may be needed either to answer the question or to clarify aspects of research already completed.

Traditionally emphasis is placed on vital sign recording to indicate the severity of an illness, and with the advent of Paediatric Early or Advanced Warning Score systems (PEWS / PAWS) ( Monaghan 2005) there is now widespread use of these tools in the assessment of improving or worsening of the presenting illness. Tucker et al (2009) found PEWS were a reliable form of identifying children who are at risk of deterioration. Experientially it has been noted that a child may not have a change in these values initially and it is difficult to explain that ‘gut instinct’ is saying that the child is better or worse. Conversely some children who score highly on these systems are not unduly sick. In practice this has an impact on prioritising care in a busy paediatric assessment unit with less experienced staff having difficulty in recognising how ill the child potentially may or may not be. For the purpose of this study, a review of research will be undertaken to see as to whether there is any robust evidence that shows their value in identifying and more significantly subsequently prioritising the management of a sick child.

Therefore a research question was formulated, asking if observations of vital signs in children really indicate how sick they are and are they effective in prioritising care.

A widely used triage system, the Manchester Triage System (MTS) (Mackway- Jones 2004) has noted flaws when used for children. The use of some triage systems that are also used for adults may yield false security; an example is if a category picked does not mention abdominal pain and the child does have this symptom the child may be under prioritised, as abdominal pain is more of a concern in children than adults (Nocera and Garner 1999). Conversely a child with pyrexia can be over triaged using the Manchester triage system.

Research question
Do observations of vital signs really indicate how sick a child is - Would this be an effective triage tool?

Define terms
To ensure that the reader is conversant with the terms, in the same context as the author; the following explanations are given:

Vital signs: these are usually defined as the observation of various physiological signs within the body that aid identification of its functional status. Usually this relates to temperature, pulse, respiration rate and blood pressure, but in children particularly, another sign is capillary refill time. Most paediatric units now use a system where these signs can score cumulating in an end score which indicates general concern and can relate to change in condition (PEWS/PAWS)

Children: as defined by the United Nations (1989) are human beings under the age of 18.

Triage – the concise Oxford dictionary 1992, p1303 explains this comes from the French verb ‘trier’: meaning to pick or cull, the context in which we use this word relating to medical assessment, is the process of sorting patients into groups and aligning priorities to these groups (as in the Manchester Triage system (MTS)

Literature search
This was completed by reviewing English language literature using aspects of the research question relating to the assessment of children less than 16 years. Searches for relevant papers and publications were made using Medline, Ovid, and British Nursing Index; also papers found by these searches and considered relevant to the topics were used to identify further articles from their reference lists. Specific keywords used to identify relevant papers were namely: vital signs, PEWS, paediatric early warning scores, triage and children. The last...
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