Comparison between the Smart Triage model and the Emergency Triage Assessment and Treatment (ETAT) guidelines in triaging children presenting to the emergency departments of two public hospitals in Kenya

Author:

Kamau Stephen,Kigo Joyce,Mwaniki Paul,Dunsmuir Dustin,Pillay Yashodani,Zhang Cherri,Nyamwaya Brian,Kimutai David,Ouma Mary,Mohammed Ismael,Gachuhi Keziah,Chege Mary,Thuranira Lydia,Ansermino J Mark,Akech Samuel

Abstract

AbstractSeveral triage systems have been developed, but little is known about their performance in low-resource settings. Evaluating and comparing novel triage systems to existing triage scales provides essential information about their added value, reliability, safety, and effectiveness before adoption. This prospective observational study included children aged < 15 years who presented to the emergency departments of two public hospitals in Kenya between February and December 2021. We compared the performance of Emergency Triage Assessment and Treatment (ETAT) guidelines and Smart Triage (ST) models (ST-only model,ST model with independent triggers, andrecalibrated ST model with independent triggers) in categorizing children into emergency, priority, and non-urgent triage categories. We visualized changes in classification of participants using Sankey diagrams. 5618 children were enrolled, and the majority (3113, 55.4%) were aged between one and five years of age. Overall admission and mortality rates were 7% and 0.9%, respectively.ETATclassified less children, 513 (9.2%), into the emergency category compared to 790 (14.1%), 1163 (20.8%) and 1161 (20.7%) by theST-only model,ST model with independent triggersandrecalibrated model with independent triggers, respectively.ETATalso classified more children, 3089 (55.1%), into the non-urgent triage category compared to 2442 (43.6%), 2097 (37.4%) and 2617 (46.7%) for the respectiveST models.ETATclassified 191/395 (48.4%) of admitted patients as emergency compared to more than half by all theST models.ETATand theST-only modelclassified 25/49 (51%) children who died as emergencies, while theST models with independent triggersclassified 39/49 (79.6%) children as emergencies. Smart Triage shows potential for identifying critically ill children in low-resource settings, particularly when combined with independent triggers. Additionally, it performs comparably toETAT. Evaluation of Smart Triage in other contexts and comparison to other triage systems is required.Author summaryPrioritizing children according to the level of severity of illness in the outpatient department is crucial to ensure very sick children are identified and receive life-saving treatment while those with less severe symptoms can safely wait in the queue. Appropriate triage prevents avoidable paediatric mortality. As new triage systems are developed, it is essential to evaluate their performance before being used by healthcare professionals to manage patients. In this study, we compared a newly developed triage algorithm, Smart Triage, to the World Health Organization’s Emergency Triage Assessment and Treatment (ETAT) guidelines. Here, we highlight how participants were categorised into emergency, priority, and non-urgent categories by both triage systems. We also assessed changes in triage categorization by comparing the Smart Triage model only (with and without site specific recalibration) and the model with independent emergency and priority triggers aligned withETAT. Our study shows that Smart Triage had comparable performance toETAT,and it can be used to triage children in resource-limited settings. Smart Triage can be integrated into a digital device allowing frontline healthcare workers to rapidly triage children presenting to the outpatient department and recognize very sick children faster, so that they can be treated in a timely manner.

Publisher

Cold Spring Harbor Laboratory

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3