Evaluation of CABS score based on vitals in children at admission for prediction of severity of illness and outcome





Triage, Scoring systems, Outcome, Mortality


Background: Triage in an emergency is sorting out the patients based on the severity of illness and prioritizing care accordingly. Kumar et al devised a score taking temperature, heart rate, respiratory rate, blood pressure, capillary refill time, oxygen saturation, and sensorium. We propose to evaluate a sickness scoring system based on capillary refill time, sensorium using AVPU score, blood pressure, and oxygen saturation by pulse oximetry (CABS) which are least affected by stress, anxiety, temperature, acidosis, etc.

Methods: Prospective study in children admitted consecutively in the age group one month to 12 years from 1st January 2019 to 31st December 2019, to paediatric intensive care unit. Triage score applied at the time of the first contact. Each variable in the study was scored as 0 for being normal and a score of 1 for being abnormal. The total score for each child is obtained. The outcome at discharge was correlated with the study variables and total score. ROC curve analysis was done for the overall predictive ability of the score.

Results: Of 346 children admitted, 27 expired, and 319 children were discharged. The risk of mortality increased with the increasing score. CFT, sensorium, blood pressure, and oxygen saturation are all significantly associated with mortality. A cut-off score of 2 has the highest sensitivity and specificity of 96.3% and 70.2%. The total score has 90% predictive accuracy as AUC is 0.913.

Conclusions: As no special training is required for its implementation, the score is promising as a triage tool in resource-poor settings.


Gove S, Tamburlini G, Molyneux E, Whitesell P, Campbell H. Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries. Arch Dis Child. 1999;81(6):473-7.

Razaq M, Harish R, Kumar D, Shora T. Physical and Non-invasive Variables of Emergency Triage in Relation to Outcome of Hospitalized Children. Int J Sci Study. 2015;3(4):20-4.

Mackway-Jones K, Robertson C. Emergency triage. Brit Med J. 1997;314(7086):1056.

Comstedt P, Storgard M, Lassen A. Systemic Inflammatory Response Syndrome in acutely hospitalized patients, a cohort study. Scand J Trauma Resusc Emerg Med. 2009;17:67.

South African Triage Scale (SATS). Emergency Medicine Society of South Africa; 2012. Available at: https://emssa.org.za/special-interest-groups/the-south-african-triage-scale-sats/. Accessed on 2021 Feb 26.

Reynolds TA, Wallis LA. Addressing African acute care needs through consensus-building. African J Emerg Med. 2013;3(1):1-2.

Singhal D, Kumar N, Puliyel JM, Singh SK, Srinivas V. Prediction of mortality by application of PRISM Score in intensive care unit. Indian paediatrics. 2001;38:714-9.

Kumar N, Thomas N, Singhal D, Puliyel JM, Sreenivas V. Triage Score for severity of illness: Indian Pediatrics. 2003;40:204-10.

John M, Goddard FC. Pediatric Risk of Mortality (PRISM) score overestimates the severity of illness in infants. Crit Care Med.1992;20:1662-5.

Wells M, Reira-Fanego JF, Luyt DK, Dance M, Lipman J. Poor discriminatory performance of the pediatric risk of mortality (PRISM) score in South African Intensive Care Unit. Crit care med. 1997;25(4):716-7.

Robertson MA, Molyneux EM. Description of cause of serious illness and outcome in patients identified using ETAT guidelines in Urban Malawi. Arch Dis Child. 2001;85:214-7.

Roukema J, Steyerberg EW, Meurs AV, Ruige M, Van der Lei J, Moll H A. Validity of the Manchester Triage System in paediatric emergency care Emerg Med J. 2006;23(12):906-10.

Thompson N, Coad N, Harnden A, Mayon white R. How well do vital signs identify children with serious infections in Pediatric Emergency Care? Arch Dis Child. 2009;94(11):888-93.

Shah SA, Fleming S, Thompson M, Tarassenko L. Respiratory rate estimation during triage of children in hospitals. J Med Eng Technol. 2015;39(8):514-24.

Pranam GM, Pranam U, Manjunath GA. Triaging in Acutely Ill Child. Indian J Trauma Emerg Pediatr. 2016;8(1):31-4.

Bains HS, Soni RK. A simple clinical score “TOPRS” to predict outcome in pediatric emergency department in a teaching hospital in India. Iran J pediatr. 2012;22(1):97.

Engan M, Hirth A, Trønnes H. Validation of a modified triage scale in a Norwegian pediatric emergency department. Int J pediatr. 2018;2018.

Ageron FX, Porteaud J, Evain JN, Millet A, Greze J, Vallot C et al. Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity scores matching analysis. World J Emerg Surg. 2021;16(1):1-9.






Original Research Articles