Performance characteristics of a local triage tool and internationally validated tools among under-fives presenting to an urban emergency department in Tanzania

Nafsa R Marombwa,Nanyori J Lucumay,Said S Kilindimo,Juma A Mfinanga,Upendo George,Kilalo M Mjema,Ellen J Weber,Hendry R Sawe

doi:10.1186/s12887-019-1417-7

Abstract

BackgroundA 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.MethodologyProspective 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.ResultsA 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%.ConclusionAll 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.

Highlights

A number of region-specific validated triage systems exist; very little is known about their performance in resource limited settings
Using Local Triage System (LTS), 67(17.4%) patients were triaged in level one, 291(75.8%) level 2 and 26 (6.8%) in level 3 categories
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%)

Summary

Introduction

A number of region-specific validated triage systems exist; very little is known about their performance in resource limited settings. Triage is the process of determining the priority of a patient to receive medical care based on the urgency and severity of their condition. It involves categorising patients into different urgency levels according to their medical complaints, vital signs, symptoms and available resources so that the most acutely ill are seen first [1, 2]. Emergency Severity Index (ESI) differs from other triage scales in that, it determines the patient’s urgency based on their presentation and predicts the resource utilization as well as estimating resource utilisation for lower acuity categories [5]. It uses triage early warning scores (TEWS) to predict the acuity level [8]

Results

Discussion

Conclusion