Irish Children's Triage System: Limb Problem

Parameters

Findings

Category

hemorrhage

exsanguinating

1

severe

2

moderate uncontrolled

3

other

4

none

5

abnormal vital signs

category 1

1

category 2

2

category 3

3

shock

uncompensated

1

compensated

2

none

5

Glasgow coma scale

<= 12

1

13 or 14

2

15

5

penetrating trauma

moderate or severe

2

minor

4

none

5

pain

severe (VAS >= 7)

2

moderate (VAS 4-6)

3

mild (1 to 3)

4

none

5

history of bleeding disorder

positive, with swelling present

2

positive, not actively bleeding

3

negative

5

joint pain

with fever, limp or heat

3

with pain

4

none

5

duration

less than 48 hours (recent) or acute symptoms

4

> 48 hours without acute symptoms

5

history or mechanism

significant

2

inconsistent with findings

3

consistent

5

amputation

complete traumatic

2

partial, > 50%

2

other

3

none

5

cast

tight with neurovascular compromise

3

damaged, wet or broken

5

weight bearing

unable to weight bear

3

partial

4

able

5

Other Parameters

Category

airway compromise

1

respiratory failure/arrest

1

temperature > 40°C

2

temperature <= 35.5°C

2

open fracture, deformity or significant swelling

2

central capillary refill time > 2 seconds

2

neurovascular compromise

2

critical skin over fracture site

2

degloving

2

history of sickle cell disease

2

swollen limb

4

history of pyrexia

4

inflammation

4