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Reliability and validity of pediatric triage tools evaluated in Low resource settings: a systematic review
Bhakti Hansoti1, Alexander Jenson2, Devin Keefe2
1Department of Emergency Medicine, Johns Hopkins School of Medicine, 1830 Monument St Suite 6-100, Baltimore, MD, 21287, USA. Bhansot1@jhmi.edu.
Insights
Reliability and validity of pediatric triage tools in low-income countries are poorly understood. This review found scarce studies with varied methodologies, hindering tool comparison for critically ill children.
Area of Science:
- Global Health
- Pediatric Emergency Medicine
- Health Systems Research
Background:
- Pediatric mortality from preventable conditions is high in low and middle-income countries (LMICs).
- Existing tools aim to prioritize critically ill children in resource-limited settings.
- No comprehensive analysis exists on the reliability and validity of these pediatric triage tools in LMICs.
Purpose of the Study:
- To systematically review and analyze the reliability and validity of pediatric triage tools used in low-resource settings.
- To identify gaps in the evidence base for pediatric triage tool evaluation in LMICs.
Main Methods:
- Systematic literature search (2000-2015) of multiple databases (Cochrane, EMBASE, Medline, PubMed, Web of Science).
- Inclusion criteria: studies evaluating reliability and validity of triage tools in LMICs.
- Data extraction by two independent reviewers on tool components, reliability, and validity.
Main Results:
- Seven studies evaluated pediatric triage tools; 10 evaluated Integrated Management of Childhood Illness (IMCI).
- Significant heterogeneity observed in methods for assessing reliability and validity (settings, outcomes, statistics).
Conclusions:
- Evidence on the reliability and validity of pediatric triage tools in LMICs is scarce.
- Methodological variations prevent robust comparison of different triage tools across study sites.
- Further standardized research is needed to validate these critical tools.
Background:
Despite the high burden of pediatric mortality from preventable conditions in low and middle income countries and the existence of multiple tools to prioritize critically ill children in low-resource settings, no analysis exists of the reliability and validity of these tools in identifying critically ill children in these scenarios.
Methods:
The authors performed a systematic search of the peer-reviewed literature published, for studies pertaining to for triage and IMCI in low and middle-income countries in English language, from January 01, 2000 to October 22, 2013. An updated literature search was performed on on July 1, 2015. The databases searched included the Cochrane Library, EMBASE, Medline, PubMed and Web of Science. Only studies that presented data on the reliability and validity evaluations of triage tool were included in this review. Two independent reviewers utilized a data abstraction tool to collect data on demographics, triage tool components and the reliability and validity data and summary findings for each triage tool assessed.
Results:
Of the 4,717 studies searched, seven studies evaluating triage tools and 10 studies evaluating IMCI were included. There were wide varieties in method for assessing reliability and validity, with different settings, outcome metrics and statistical methods.
Conclusions:
Studies evaluating triage tools for pediatric patients in low and middle income countries are scarce. Furthermore the methodology utilized in the conduct of these studies varies greatly and does not allow for the comparison of tools across study sites.
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