Prospective Validation of a Novel Triage System Developed in a Middle Income Country - AIIMS Triage Protocol.

Area of Science:

• Emergency Medicine
• Healthcare Systems Research

Background:

• Triage is vital for patient management and resource allocation in emergency departments (EDs).
• Low- and middle-income countries (LMICs) often rely on informal triage, with limited validated systems.
• The All India Institute of Medical Sciences (AIIMS) triage protocol (ATP) was developed via expert consensus using the Delphi method.

Purpose of the Study:

• To prospectively validate the ATP for adult patients.
• To assess ATP's accuracy in predicting 24-hour mortality and intensive care unit (ICU) admission.

Main Methods:

• Prospective validation study involving adult patients (14 years and above) presenting to the ED.
• Patients were followed for 24 hours to document mortality and ICU/hospital admission.
• Data collected using standardized forms.

Main Results:

• 13,754 patients were analyzed; 45.83% triaged red, 54.17% triaged yellow.
• 24-hour mortality was significantly higher in red-triaged patients (10.31%) compared to yellow (0.35%).
• ATP 'Red' criteria showed 96.2% sensitivity and 56.8% specificity for 24-hour mortality; 98.5% sensitivity and 59.6% specificity for 24-hour ICU admission.

Conclusions:

• The ATP demonstrated high accuracy in identifying critically ill adult nontrauma patients in the ED.
• The ATP is a validated and potentially effective triage system for public hospital EDs in LMICs.