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Triage and resuscitation tools for low and middle income countries: how to catch the killer?
Indumathy Santhanam1, Prinetha Moodley2,3, Balaji Jayaraman4
1Pediatric Emergency Medicine, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India.
Insights
Improving emergency care for critically unwell children in low- and middle-income countries (LMIC) is vital. Early recognition through triage and systematic assessment significantly reduces child mortality by ensuring timely resuscitation.
Area of Science:
- Pediatrics
- Emergency Medicine
- Global Health
Background:
- High under-5 mortality rates persist in low- and middle-income countries (LMIC).
- Failure to recognize critically ill children upon presentation leads to delayed resuscitation and increased mortality.
- Children in LMIC often present late with multiorgan dysfunction.
Purpose of the Study:
- To highlight the critical role of triage and systematic primary survey in emergency care for critically unwell children in resource-limited settings.
- To emphasize the importance of repeated physiological assessments for guiding resuscitation decisions.
- To advocate for the adaptation of existing resources to local contexts to improve child survival.
Main Methods:
- Focus on the patient's journey through emergency care: triage, primary survey, and initial stabilization.
- Utilizing systematic approaches and repeated physiological assessments.
- Adapting developed resources to local healthcare structures and processes.
Main Results:
- A systematic approach to triage and resuscitation can significantly improve survival rates.
- Effective recognition and management of critically unwell children are achievable even with limited resources.
- Structured interventions in emergency care directly impact patient outcomes.
Conclusions:
- Implementing systematic triage and primary survey is crucial for reducing under-5 mortality in LMIC.
- Adaptation of evidence-based resources to local contexts is essential for effective implementation.
- A systematic approach to emergency care saves lives of critically unwell children.
Abstract:
Under-5 mortality rates in low and middle-income countries (LMIC) remain high. One major contributing factor is the failure to recognise critically unwell children when they first present to hospital. This leads to delayed or inadequate resuscitation and an increased risk of death.Triage is a key skill in this setting to sort the queue and prioritise patients, even when staff and equipment are scarce. In LMIC, children generally present late in their illness and often have progressed to some degree of multiorgan dysfunction.Following triage, a structured systematic primary survey is critical to ensure the detection of subtle signs of multiorgan dysfunction. Repeated physiological assessments of the child guide subsequent resuscitation management decisions, which depend somewhat on the resources available.It is possible to achieve significant improvements in survival of critically unwell children presenting for emergency care in the resource-limited setting. The three key steps in the patient's journey that we can influence in emergency care are triage, primary survey and initial stabilisation. Resources that address these steps have been developed for all settings. However, these resources were developed in a specific clinical context, and must therefore be adapted to local structures and processes. A systematic approach to triage and resuscitation saves lives.
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