Triage in the developing world---can it be done?

Abstract

Aim-To assess guidelines for the emergency triage, assessment, and treatment (ETAT) of sick children presenting to hospitals in the developing world. This study pretested the guidelines in Malawi, assessing their performance when used by nurses compared to doctors trained in advanced paediatric life support (APLS). Methods-Triage was performed simultaneously by a nurse and assessing doctor on 2281 children presenting to the under 5s clinic. Each patient was allocated one of three priorities, according to the ETAT guidelines. Any variation between nurse and assessor was recorded on the assessment forms. Results-Nurses identified 92 children requiring emergency treatment and 661 with signs indicating a need for urgent medical assessment. One hundred and forty two (6.2%) had diVerent priorities allocated by the APLS trained doctor, but these children did not tend to need subsequent admission. Eighty five per cent of admissions were prioritised to an emergency or urgent category. Conclusion-Although there are no gold standards for comparison the ETAT guidelines appear to reliably select out the majority of patients requiring admission.

Evaluation of Fundamental Critical Care Course in Kenya: Knowledge, Attitude, and Practice

“…As we showed in this course, nurses can effectively learn new clinical skills after a short course. A short 20-h training course in emergency triage assessment and treatment (ETAT) was successful in training eight nurses in urban Malawi to accurately triage more than 2000 children and impact inpatient mortality [27]. Therefore, our results after the FCCS course are consistent with the literature on other short courses in developing countries.…”

Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study

“…Does this child need immediate cardiopulmonary resuscitation (airway, breathing, circulation), including oxygen, fluid resuscitation, urgent blood transfusion*, glucose, or anticonvulsants?26 – 28…”

An adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation

“…It therefore can be applied to any malaria-prone sub-Saharan African region. [5] It has also been validated in a malaria-free developing setting and found to perform well. [6] Up to 90% of children admitted had emergency or priority signs, and more than 90% of children categorised as having non-urgent problems were discharged.…”

“…It has been validated in several clinical settings. [5,6] Healthcare staff are trained to recognise life-threatening problems by identifying the key emergency signs in this ' A-B-C-D' approach, where A and B denote Airway and Breathing problems, C indicates Circulation, Coma and Convulsions, and D denotes severe Dehydration (diarrhoea). These emergency and priority features are grouped into a 'red' category indicating the need for immediate care and an 'orange' category for children with urgent problems who should be directed to the 'priority' queue, while those with non-urgent problems are coded 'green' and can wait to be seen.…”