• Gabor D Kelen, Lauren Sauer, Eben Clattenburg, Mithya Lewis-Newby, and James Fackler.
• The Department of Emergency Medicine,The Johns Hopkins University School of Medicine,Baltimore,Maryland.
• Disaster Med Public Health Prep. 2015 Jun 1;9(3):283-90.

BackgroundCritically insufficient pediatric hospital capacity may develop during a disaster or surge event. Research is lacking on the creation of pediatric surge capacity. A system of "reverse triage," with early discharge of hospitalized patients, has been developed for adults and shows great potential but is unexplored in pediatrics.MethodsWe conducted an evidence-based modified-Delphi consensus process with 25 expert panelists to derive a disposition classification system for pediatric inpatients on the basis of risk tolerance for a consequential medical event (CME). For potential validation, critical interventions (CIs) were derived and ranked by using a Likert scale to indicate CME risk should the CI be withdrawn or withheld for early disposition.ResultsPanelists unanimously agreed on a 5-category risk-based disposition classification system. The panelists established upper limit (mean) CME risk for each category as <2% (interquartile range [IQR]: 1-2%); 7% (5-10%), 18% (10-20%), 46% (20-65%), and 72% (50-90%), respectively. Panelists identified 25 CIs with varying degrees of CME likelihood if withdrawn or withheld. Of these, 40% were ranked high risk (Likert scale mean ≥7) and 32% were ranked modest risk (≤3).ConclusionsThe classification system has potential for an ethically acceptable risk-based taxonomy for pediatric inpatient reverse triage, including identification of those deemed safe for early discharge during surge events.

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