Pediatric Assessment Triangle

Authors: Michelle Reina, MD, Rob Bryant, MD
Updated: 5/30/2013

Pediatric Assessment Triangle

Pediatric assessment triangle

The PAT functions as a rapid, initial assessment to determine “sick” or “not sick,” and should be immediately followed by/not delay the ABCDEs. It can be utilized for serial assessment of patients to track response to therapy.

Appearance: The “Tickles” (TICLS) Mnemonic

Characteristic Normal features
Tone Move spontaneously, resists examination, sits or stands (age appropriate)
Interactiveness Appears alert/engaged with clinician or caregiver, interacts well with people/environment, reaches for objects
Consolability Stops crying with holding/comforting by caregiver, has differential response to caregiver vs. examiner
Look/gaze Makes eye contact with clinician, tracks visually
Speech/cry Uses age-appropriate speech

Work of breathing

Characteristic Abnormal features
Abnormal airway sounds Snoring, muffled/hoarse speech, stridor, grunting, wheezing
Abnormal positioning Sniffing position, tripoding, prefers seated posture
Retraction Supraclavicular, intercostal, or substernal, head bobbing (infants)
Flaring Flaring of the nares on inspiration

Circulation of skin

Characteristic Abnormal features
Pallor White/pale skin or mucous membranes
Mottling Patchy skin discoloration due to variable vasoconstriction
Cyanosis Bluish discoloration of skin/mucous membranes

Relationship of the PAT components to physiological categories and management priorities

Presentation Appearance Work of breathing Circulation Management
Stable Normal Normal Normal Specific therapy based on possible etiologies
Respiratory distress Normal ABNORMAL Normal Position of comfort, O2/suction, specific therapy (e.g. albuterol, diphenhydramine, epinephrine), labs/x-rays
Respiratory failure ABNORMAL ABNORMAL Normal or ABNORMAL Position head/open airway, BVM, FB removal, advanced airway, labs/x-rays
Shock (compensated) Normal Normal ABNORMAL O2, peripheral IV, fluid resuscitation, specific therapy based on etiology (antibiotics, surgery, antidysrhythmics), labs/x-rays
Shock (decompensated/hypotensive) ABNORMAL Normal or ABNORMAL ABNORMAL O2, vascular access, fluid resuscitation, specific therapy based on etiology (antibiotics, vasopressors, blood products, surgery, antidysrhythmics, cardioversion), labs/x-rays
CNS/Metabolic dysfunction ABNORMAL Normal Normal O2, POC glucose, consider other etiologies, labs/x-rays
Cardiopulmonary failure/arrest ABNORMAL ABNORMAL ABNORMAL Position head/open airway, BMV with 100% O2, CPR, specific therapy based on etiology (defibrillation, epinephrine, amiodarone), labs/x-rays


  • Dieckmann RA, Brownstein D, Gausche-Hill M. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010 Apr;26(4):312-5. doi: 10.1097/PEC.0b013e3181d6db37. [PubMed]
  • ER CAST: Courtesy of Dr. Michelle Reina & Dr. Rob Bryant [Source]