Validity and reliability of the Interagency Integrated Triage Tool in a regional emergency department in Papua New Guinea

Abstract

Objective: The Interagency Integrated Triage Tool (IITT) is a novel, three-tier triage system recommended by the World Health Organization. The present study sought to assess the validity and reliability of a pilot version of the tool in a resource-limited ED in regional Papua New Guinea. Methods: This pragmatic prospective observational study, conducted at Mount Hagen Provincial Hospital, commenced 1 month after IITT implementation. The facility did not have a pre-existing triage system. All ED patients presenting within a 5-month period were included. The primary outcome was sensitivity for the detection of time-critical illness, defined by 10 pre-specified diagnoses. The association between triage

Multimodal learning for emergency department triage implementation: experiences from Papua New Guinea during the COVID-19 pandemic

“…3 , 4 Limited data suggest the IITT can identify ED patients with urgent care needs, including those with COVID-19. 5 , 6 , 7 …”

Emergency department triage and COVID‐19: Performance of the Interagency Integrated Triage Tool during a pandemic surge in Papua New Guinea

“…Previous studies have determined the tool's sensitivity to be 70.8% and 77.8% for identifying patients with time‐sensitive diagnoses such as acute coronary syndrome and ruptured ectopic pregnancy. 3 , 4 Collectively, these figures are within the performance range of other triage systems to detect critical illness. 5 For instance, a recent systematic review reported the sensitivity of established triage tools to identify severe sepsis as between 36% and 74%.…”

“…The IITT has shown similar performance for urgent non‐COVID conditions. Previous studies have determined the tool's sensitivity to be 70.8% and 77.8% for identifying patients with time‐sensitive diagnoses such as acute coronary syndrome and ruptured ectopic pregnancy 3,4 . Collectively, these figures are within the performance range of other triage systems to detect critical illness 5 .…”

“…Although the IITT has demonstrated acceptable performance in a pre‐pandemic context, its ability to identify COVID‐19 patients with urgent care needs has not been assessed. 3 , 4 The present study sought to determine the sensitivity of the tool to detect severe and critical COVID‐19 in a resource‐constrained setting.…”

Triage for resource-limited emergency care: why it matters

“…[10,11,19,21,22] Pilot evaluations assessing its validity and reliability have demonstrated acceptable performance. [23,24] Evidence and experience Although triage tools vary in their composition, validation studies suggest that many share similar weaknesses, including suboptimal sensitivity for the detection of time-critical illness. [5,6] In fact, a 2011 systematic review concluded that, in general, triage systems are supported by "limited and often insufficient evidence."…”