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Editor,—The proposed paediatric triage algorithm in Mackway-Jones et al's study1has a number of important flaws:
- few children younger than 10 months are ambulatory
- there is no airway opening manoeuvre
- capillary refill time is affected by the ambient temperature; refill time measured at the sternum and forehead only have a Gaussian distribution.2 To rely solely on the capillary refill time increases the number of priority 1 (immediate) children especially in cold surroundings
- the paediatric trauma score (even with the Eichelberger modification) is inappropriate as the systolic blood pressure is required. The ability to measure it at the incident, the need for different cuff sizes, and the time it takes when faced by a large number of casualties rule this score out
- there is no account made for the change in physiological parameters with age.
We have devised a triage system (on a waterproof …
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