Decreased Pediatric Hospital Mortality After an Intervention to Improve Emergency Care in Lilongwe, Malawi

Robison, Jeff A.; Ahmad, Zahida P.; Nosek, Carl A; Durand, Charlotte; Namathanga, Annie; Milazi, Robert; Thomas, Ann Mary; Soprano, Joyce V.; Mwansambo, Charles; Kazembe, Peter N.; Torrey, Susan

doi:10.1542/peds.2012-0026

Cited by 88 publications

(103 citation statements)

References 20 publications

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“…Triage is recognised as being one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. [4] However, in LMICs this strategy is underused, under-resourced and poorly researched.…”

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confidence: 99%

Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan

Dalwai

Twomey

Maïkéré³

et al. 2014

S Afr Med J

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Background. Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low-and middle-income countries this strategy is underused, under-resourced and poorly researched. Objective. To assess the inter-and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan. Methods. Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard. Results. Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 -0.85). The intrarater agreement was also high with 87% exact agreement (95% CI 67 -100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of overtriage did not exceed the acceptable threshold of 30 -50%. Under-triage was acceptable for all except emergency cases (66%). Conclusion. ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for 'very urgent' and 'routine' cases, importantly, it may under-triage 'emergency' cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed.

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confidence: 99%

Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan

Dalwai

Twomey

Maïkéré³

et al. 2014

S Afr Med J

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“…Similarly, effective triage is one of several areas where research and troubleshooting can result in striking improvements for patient outcomes with modest investment. At several centres in Malawi, for example, an improved triage system decreased sepsis mortality from 10-18% per week to 6-8% per week (14,15). Other similar attempts in the USA have improved compliance with sepsis protocols and demonstrated a trend toward mortality benefit (25,26).…”

Section: Discussionmentioning

confidence: 99%

“…Specific programmes designed to improve triage processes and sepsis recognition and adherence to goal-directed care have improved outcomes at individual institutions in both resource rich and poor environments (14)(15)(16)(17). At a global level, however, priority areas for research and intervention have not been systematically described.…”

Section: Introductionmentioning

confidence: 99%

Systems for Pediatric Sepsis: A Global Survey

et al. 2014

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“…Specifically, there is limited information about pediatric hospital admissions, mortality patterns, and cause mortality in Ethiopian hospitals [6,7]. Previous studies on pediatric hospital mortality in sub-Saharan Africa have demonstrated that deficiencies in pediatric triage, assessment, and emergency treatment at least partially accounts for high inpatient mortality, a large burden of which occurs early during hospitalization [8]. In Ethiopia, one study reported that 33 % of deaths occurred within the first 24 h of admission to the general pediatric ward [6], another reported 34 % within the first 48 h [7], while another reported 100 % of deaths within the first 24 h of admission to the pediatric ICU [9].…”

Section: Introductionmentioning

confidence: 99%

Demographic and mortality analysis of hospitalized children at a referral hospital in Addis Ababa, Ethiopia

Bohn¹,

Record²,

Kassaye³

et al. 2016

Annals of Global Health

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Background: Global childhood mortality rates remain high. Millennium Development Goal 4 focused efforts on reducing rates by two-thirds between 1990 and 2015. In Ethiopia, child mortality rates dropped 71 % from 1990 to 2015, however it is estimated that 184,000 Ethiopian children die each year. There is limited information about pediatric hospital admissions in Ethiopia. Our aims were to examine the temporal relationship of mortality to admission, describe the demographics, and identify cause mortality of children admitted to the Zewditu Memorial Hospital (ZMH). Methods: A four-year retrospective review of pediatric admissions was conducted at the pediatric emergency room and pediatric hospital ward at ZMH in Addis Ababa, Ethiopia. Admission entries from 2011-2014 of children age 29 days-14 years were reviewed. Age, gender, admission date, disease classification, discharge status and date were obtained. Patient gender was compared using Chi-square analysis. A descriptive analysis was used for age and cause mortality. Conclusions: Our study revealed a lower mortality rate than previously reported in Ethiopia. Despite this, 44 % of pediatric hospital mortality occurred early during hospitalization, higher than reported at other Ethiopian hospitals. This adds further evidence that systematic efforts should be dedicated to improve pediatric emergency care. Admissions included 58 % male patients, similar to other reports in Ethiopia implying that this may be a nation-wide phenomenon. The observed disparity may be due to societal factors regarding care-seeking behaviors or male predilection for respiratory illness warranting further investigation. Cause mortality patterns were similar to reports in analogous settings.

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Decreased Pediatric Hospital Mortality After an Intervention to Improve Emergency Care in Lilongwe, Malawi

Cited by 88 publications

References 20 publications

Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan

Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan

Systems for Pediatric Sepsis: A Global Survey

Demographic and mortality analysis of hospitalized children at a referral hospital in Addis Ababa, Ethiopia

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