Performance characteristics of a local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tanzania
Abstract Background A number of region-specific validated triage systems exist; however very little is known about their performance in resource limited settings. We compare the local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tan...
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doaj-68ad625d9fe14661bfa9e927a6693c7d2020-11-25T01:20:24ZengBMCBMC Pediatrics1471-24312019-02-011911710.1186/s12887-019-1417-7Performance characteristics of a local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in TanzaniaNafsa R. Marombwa0Hendry R. Sawe1Upendo George2Said S. Kilindimo3Nanyori J. Lucumay4Kilalo M. Mjema5Juma A. Mfinanga6Ellen J. Weber7Emergency Medicine Department, Muhimbili University of Health and Allied ScienceEmergency Medicine Department, Muhimbili University of Health and Allied ScienceEmergency Medicine Department, Muhimbili National HospitalEmergency Medicine Department, Muhimbili University of Health and Allied ScienceEmergency Medicine Department, Muhimbili University of Health and Allied ScienceEmergency Medicine Department, Muhimbili University of Health and Allied ScienceEmergency Medicine Department, Muhimbili National HospitalDepartment of Emergency Medicine, University of CaliforniaAbstract Background A number of region-specific validated triage systems exist; however very little is known about their performance in resource limited settings. We compare the local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tanzania. Methodology Prospective descriptive study of consecutive under-fives seen at Muhimbili National Hospital (MNH), ED between November 2017 to April 2018. Patients were triaged according to Local Triage System (LTS), and the information collected were used to assign acuities in the other triage scales: Canadian Triage and Acuity Scale (CTAS), Australasian Triage Scale (ATS), Manchester Triage Scale (MTS) and South African Triage Scale (SATS). Patients were then followed up to determine disposition and 24 h outcome. Sensitivity, specificity, positive and negative predictive values for admission and mortality were then calculated. Results A total of 384 paediatric patients were enrolled, their median age was 17 months (IQR 7–36 months). Using LTS, 67(17.4%) patients were triaged in level one, 291(75.8%) level 2 and 26 (6.8%) in level 3 categories. Overall admission rate was 59.6% and at 24 h there were five deaths (1.3%). Using Level 1 in LTS, and Levels 1 and 2 in other systems, sensitivity and specificity for admission for all triage scales ranged between 27.1–28.4% and 95.4–98% respectively, (PPV 90.3–95.3%, NPV 47.1–47.4%). Sensitivity for mortality was 80% for LTS, and 100% for the other scales, while specificity was low, yielding a PPV for all scales between 6.9 and 8%. Conclusion All triage scales showed poor ability to predict need for admission, however all triage scales except LTS predicted mortality. The test characteristics for the other scales were similar. Future studies should focus on determining the reliability and validity of each of these triage tools in our setting.http://link.springer.com/article/10.1186/s12887-019-1417-7TriageEmergency departmentTriage scalesAfricaTanzania |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nafsa R. Marombwa Hendry R. Sawe Upendo George Said S. Kilindimo Nanyori J. Lucumay Kilalo M. Mjema Juma A. Mfinanga Ellen J. Weber |
spellingShingle |
Nafsa R. Marombwa Hendry R. Sawe Upendo George Said S. Kilindimo Nanyori J. Lucumay Kilalo M. Mjema Juma A. Mfinanga Ellen J. Weber Performance characteristics of a local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tanzania BMC Pediatrics Triage Emergency department Triage scales Africa Tanzania |
author_facet |
Nafsa R. Marombwa Hendry R. Sawe Upendo George Said S. Kilindimo Nanyori J. Lucumay Kilalo M. Mjema Juma A. Mfinanga Ellen J. Weber |
author_sort |
Nafsa R. Marombwa |
title |
Performance characteristics of a local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tanzania |
title_short |
Performance characteristics of a local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tanzania |
title_full |
Performance characteristics of a local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tanzania |
title_fullStr |
Performance characteristics of a local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tanzania |
title_full_unstemmed |
Performance characteristics of a local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tanzania |
title_sort |
performance characteristics of a local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in tanzania |
publisher |
BMC |
series |
BMC Pediatrics |
issn |
1471-2431 |
publishDate |
2019-02-01 |
description |
Abstract Background A number of region-specific validated triage systems exist; however very little is known about their performance in resource limited settings. We compare the local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tanzania. Methodology Prospective descriptive study of consecutive under-fives seen at Muhimbili National Hospital (MNH), ED between November 2017 to April 2018. Patients were triaged according to Local Triage System (LTS), and the information collected were used to assign acuities in the other triage scales: Canadian Triage and Acuity Scale (CTAS), Australasian Triage Scale (ATS), Manchester Triage Scale (MTS) and South African Triage Scale (SATS). Patients were then followed up to determine disposition and 24 h outcome. Sensitivity, specificity, positive and negative predictive values for admission and mortality were then calculated. Results A total of 384 paediatric patients were enrolled, their median age was 17 months (IQR 7–36 months). Using LTS, 67(17.4%) patients were triaged in level one, 291(75.8%) level 2 and 26 (6.8%) in level 3 categories. Overall admission rate was 59.6% and at 24 h there were five deaths (1.3%). Using Level 1 in LTS, and Levels 1 and 2 in other systems, sensitivity and specificity for admission for all triage scales ranged between 27.1–28.4% and 95.4–98% respectively, (PPV 90.3–95.3%, NPV 47.1–47.4%). Sensitivity for mortality was 80% for LTS, and 100% for the other scales, while specificity was low, yielding a PPV for all scales between 6.9 and 8%. Conclusion All triage scales showed poor ability to predict need for admission, however all triage scales except LTS predicted mortality. The test characteristics for the other scales were similar. Future studies should focus on determining the reliability and validity of each of these triage tools in our setting. |
topic |
Triage Emergency department Triage scales Africa Tanzania |
url |
http://link.springer.com/article/10.1186/s12887-019-1417-7 |
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