Factors Associated with the Reclassification of a New Triage Tool in Pediatric Emergency Departments in Korea: A Nationwide Retrospective Observational Study

Background/Objectives: This study aimed to investigate the factors affecting triage reclassification, including down-triage and up-triage, associated with the use of a new triage tool for assessing patient urgency in pediatric emergency departments (PEDs). Methods: This was a retrospective observational study based on the national registry data of patients aged < 15 years who visited PEDs between January 2016 and December 2019. Patients were classified into no reclassification, down-triage, and up-triage groups, and the incidence and risk factors of triage reclassification and its characteristics according to hospital size were analyzed. Results: Overall, 5,462,950 patients were included, and triage reclassification occurred in 129,903 (2.4%). Down-triage and up-triage occurred in 35,897 (0.7%) and 94,006 (1.7%) patients, respectively. Among patients initially classified as PedKTAS levels 1–3, 1.87% were down-triaged, whereas 2.66% of patients initially classified as levels 4–5 were up-triaged. The down-triage-associated factors were age 1–4, 5–9, and 10–14 years, trauma group, self-referrals, and presentation to regional EMIs. The up-triage-associated factors were age of <1 year, male sex, daytime visits, visits for diseases, referral from an outpatient department or clinic, and presentation to district EMCs. There were also differences in reclassification patterns according to hospital size. Conclusions: This study identified factors related to triage reclassification in patients in PEDs. Accurate triage that considers these factors is essential for providing appropriate treatment and efficient use of PED resources.