Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure consistency of application. However, the ongoing crowding of emergency departments resulting from access block and increased demand has led to calls for a review of systems of triage. In addition, international variance in triage systems limits the capacity for benchmarking. The aim of this paper is to provide a critical review of the literature pertaining to emergency department triage in order to inform the direction for future research. While education, guidelines and algorithms have been shown to reduce triage variation, there remains significant inconsistency in triage assessment arising from the diversity of factors determining the urgency of any individual patient. It is timely to accept this diversity, what is agreed, and what may be agreeable. It is time to develop and test an International Triage Scale (ITS) which is supported by an international collaborative approach towards a triage research agenda. This agenda would seek to further develop application and moderating tools and to utilise the scales for international benchmarking and research programmes.

Contemporary approaches to child protection are dominated by individualized forensically focused interventions that provide limited scope for more holistic preventative responses to children at risk and the provision of support to struggling families and communities. However, in many jurisdictions, it is frequently shown, often through public inquiries and program reviews, that investigatory and removal approaches are failing in critically important ways, particularly regarding reducing the inequities that underpin neglect and abuse. Consequently, there have been increasing calls for a public health model for the protection of children, although there is often a lack of clarity as to what exactly this should entail. Yet, there are opportunities to learn from public health approaches successfully used in the field of injury prevention. Specifically, we advocate for the use of Haddon’s Matrix, which provides a detailed theoretical and practical framework for the application of a comprehensive and integrated public health model to guide intervention program design and responses to child protection risk factors. A broad overview of the application of Haddon’s Matrix’s principles and methods is provided with examples of program and intervention design. It is argued that this framework provides the range of interventions necessary to address the complex social and structural factors contributing to inequity and the maltreatment of children. It also provides the foundation for a holistic and integrated system of prevention and intervention to contribute to system-level change and address child maltreatment.

Internationally, research on child maltreatment-related injuries has been hampered by a lack of available routinely collected health data to identify cases, examine causes, identify risk factors and explore health outcomes. Routinely collected hospital separation data coded using the International Classification of Diseases and Related Health Problems (ICD) system provide an internationally standardised data source for classifying and aggregating diseases, injuries, causes of injuries and related health conditions for statistical purposes. However, there has been limited research to examine the reliability of these data for child maltreatment surveillance purposes. This study examined the reliability of coding of child maltreatment in Queensland, Australia.

International data on child maltreatment are largely derived from child protection agencies, and predominantly report only substantiated cases of child maltreatment. This approach underestimates the incidence of maltreatment and makes inter-jurisdictional comparisons difficult. There has been a growing recognition of the importance of health professionals in identifying, documenting and reporting suspected child maltreatment. This study aimed to describe the issues around case identification using coded morbidity data, outline methods for selecting and grouping relevant codes, and illustrate patterns of maltreatment identified.