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Triage in the developing world--can it be done?
1Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.
Insights
Emergency Triage, Assessment, and Treatment (ETAT) guidelines reliably identify most children needing hospital admission in developing countries. Nurses effectively used these guidelines, showing their utility in pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Global Health
- Clinical Guidelines
Background:
- Effective emergency triage is crucial for managing sick children in resource-limited settings.
- Existing guidelines need validation in diverse healthcare environments.
Purpose of the Study:
- To evaluate the performance of Emergency Triage, Assessment, and Treatment (ETAT) guidelines for sick children in a developing country.
- To compare the accuracy of nurses versus advanced pediatric life support (APLS)-trained doctors in applying ETAT guidelines.
Main Methods:
- A prospective study involving 2281 children presenting to an under-5 clinic in Malawi.
- Simultaneous triage by nurses and assessing doctors using ETAT guidelines, with variations recorded.
- Prioritization of patients into three categories based on ETAT criteria.
Main Results:
- Nurses identified a significant number of children needing emergency treatment or urgent assessment.
- Discrepancies in prioritization between nurses and doctors were noted in 6.2% of cases, but these did not correlate with subsequent admissions.
- 85% of admitted children were correctly categorized as requiring emergency or urgent care.
Conclusions:
- The ETAT guidelines demonstrate reliability in identifying the majority of children who require hospital admission.
- Nurses can effectively utilize ETAT guidelines for pediatric triage in developing world settings.
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 different 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.
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