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

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.Electronic supplementary materialThe online version of this article (10.1186/s12887-019-1417-7) contains supplementary material, which is available to authorized users.

The midwives’ experiences of the use of obstetric triage and obstetric triage tool during labour in Bojanala district

“…Overcrowding and low staff numbers can result in women's waiting times in the OBT areas being between 15 min and 100 min, with a maximum of up to one full day (Floyd et al 2018). In support, Marobwa et al (2019) reported that women with high-risk conditions such as pre-eclampsia often complicate in instances where they need to queue for assistance, thus causing negative perinatal outcomes. On a positive note, the midwives understand the detrimental effects of increased waiting times to triage, and this could be used as a point of departure in reducing waiting time in the OBT.…”

Epidemiology and treatment of sepsis at a public pediatric emergency department

“…(26)(27)(28)(29) In emergency departments, triage scores, such as the Manchester, the Canadian Triage and Acuity Scale (CTAS), the Australian Triage Scale (ATS) and the South African Triage Scale (SATS) were predictive of mortality in children. (30) In the study hospital, the triage score was not validated for mortality.…”

‘A tool we need’: Midwives’ descriptions and recommendations of an ideal obstetric triage tool

“…An OBTT thus ensures continuity of care and prevents repetition of nursing care, thus preventing medicolegal hazards (Van Graan, Williams & Koen 2016). The condition of a woman in labour is detailed, and a classification based on the existing and potential problems is carried out, which helps to reduce the waiting time (Marombwa et al 2019). An increase in waiting time has been associated with a higher rate of negative perinatal outcomes as the clinical conditions are worsened (Alharbi et al 2018).…”

“…An increase in waiting time has been associated with a higher rate of negative perinatal outcomes as the clinical conditions are worsened (Alharbi et al 2018). The ability of a complete OBTT to ensure a timeous and standardised plan of care is executed, and it is associated with an increase in positive pregnancy outcomes (Marombwa et al 2019).…”