Emergency Triage Assessment Research Articles

Implementation of ETAT (Emergency Triage Assessment And Treatment) in a central hospital in malawi

AimsThe Under 5 clinic in this busy central hospital in Malawi is the initial point of care for acutely ill children who require admission; 200–300 children are seen in the...

Emergency triage assessment for hypoxaemia in neonates and young children in a Kenyan hospital: an observational study.

To describe the prevalence of hypoxaemia in children admitted to a hospital in Kenya for the purpose of identifying clinical signs of hypoxaemia for emergency triage assessment, and to test the hypothesis that such signs lead to correct identification of hypoxaemia in children, irrespective of their diagnosis. From 2002 to 2005 we prospectively collected clinical data and pulse oximetry measurements for all paediatric admissions to Kilifi District Hospital, Kenya, irrespective of diagnosis, and assessed the prevalence of hypoxaemia in relation to the WHO clinical syndromes of 'pneumonia' on admission and the final diagnoses made at discharge. We used the data collected over the first three years to derive signs predictive of hypoxaemia, and data from the fourth year to validate those signs. Hypoxemia was found in 977 of 15 289 (6.4%) of all admissions (5% to 19% depending on age group) and was strongly associated with inpatient mortality (age-adjusted risk ratio: 4.5; 95% confidence interval, CI: 3.8-5.3). Although most hypoxaemic children aged > 60 days met the WHO criteria for a syndrome of 'pneumonia' on admission, only 215 of the 693 (31%) such children had a final diagnosis of lower respiratory tract infection (LRTI). The most predictive signs for hypoxaemia included shock, a heart rate < 80 beats per minute, irregular breathing, a respiratory rate > 60 breaths per minute and impaired consciousness. However, 5-15% of the children who had hypoxaemia on admission were missed, and 18% of the children were incorrectly identified as hypoxaemic. The syndromes of pneumonia make it possible to identify most hypoxaemic children, including those without LRTI. Shock, bradycardia and irregular breathing are important predictive signs, and severe malaria with respiratory distress is a common cause of hypoxaemia. Overall, however, clinical signs are poor predictors of hypoxaemia, and using pulse oximetry in resource-poor health facilities to target oxygen therapy is likely to save costs.

Improving the quality of emergency care for children in developing countries

The paper by Molyneux et al. in this issue of the Bulletin contains several valuable lessons for health professionals in developing countries. (1) Beyond the specific technical content, it shows how problems in health service delivery can be solved successfully through a systematic process of quality improvement: identifying a specific problem, addressing that problem through simple, low-cost, locally available and effective solutions, and evaluating the approach. Molyneux et al. improved emergency care for children by providing training in emergency care and triage and improving patient flow and collaboration between inpatient and outpatient services. Emergency triage assessment and treatment (ETAT) was developed in Malawi, based upon and validated against the Advanced Paediatric Life Support course used as the standard training for paediatric emergencies in many developed countries. The ETAT course has been conducted as a 3 1/2-day training course in several resource-poor countries, and trainer of trainer courses have been held in the Africa and South-East Asia Regions. (2) The ETAT course materials have been translated into several languages. Similar emergency care guidelines have been used in Brazil. (3) Good quality emergency care can be the first step in improving hospital care for children, which is deficient in many countries. (3-5) Experience is accumulating from resource-poor countries: the management of cases of severe malnutrition, (6-8) pneumonia (9) and neonatal care (10) has been improved with better ward organization, clinical guidelines and staff participation. Quality improvement as a strategy has been used by several projects. In Nicaragua, the Russian Federation and South Africa, projects improving services for neonatal care have resulted in good outcomes ranging from immediate care of the newborn to a reduction in neonatal mortality. In Peru, a large-scale maternal and neonatal quality improvement project with self-identification of problems by the clinical teams, training, supervision and an accreditation system resulted in a range of improvements. (11) These included the availability of data on which to base clinical care, patient satisfaction, the availability of essential supplies, a participatory working approach and standardized care. Quality improvement depends on showing a discrepancy between the existing situation and desired standards. In Brazil, a hospital assessment tool was initially developed and field-tested with involvement of local professionals and concurrent data collection, assessment and planning of identified improvements. (11) This tool was the prototype for subsequent hospital assessments in countries such as Cambodia, Indonesia, Kazakhstan, Kenya, Solomon Islands and Timor Leste, where the findings were the basis for initiating hospital improvement activities. …

Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries

Simplified guidelines for the emergency care of children have been developed to improve the triage and rapid initiation of appropriate emergency treatments for children presenting to hospitals in developing countries....

Evaluation of guidelines for emergency triage assessment and treatment in developing countries

AIMTo evaluate performance of a simplified algorithm and treatment instructions for emergency triage assessment and treatment (ETAT) of children presenting to hospital in developing countries.METHODSAll infants aged 7 days to...