Comparison of local, australasian, manchester, canadian and south african triage scales in predicting outcomes of paediatric patients below the age of 5 years with non traumatic medical complaints presenting to the Muhimbili National Hospital, emergency medicine department.

Abstract

ABSTRACT Background: Triage of paediatric patients pose a unique challenge due to several factors such as need for special communication skills for providers and difference in response to physiological stressors in paediatric population. While several region’s specific validated triage systems exist in the world, Tanzania lack context –appropriate, validated triage tools. Emergency Medicine Department (EMD) at Muhimbili National Hospital (MNH) in Tanzania uses a local triage system based on emergency severity index whose performance in relation to other triage systems is unknown. Objective: To compare the performance of local, Australasian, Manchester, Canadian and South African triage scale in predicting outcomes below the age of 5 years with non traumatic medical complaints presenting to the MNH-EMD Methodology: This was prospective descriptive study of Paediatric patients presenting to the EMD-MNH, from November 2017 to April 2018. Purposively designed data collection form was used to record patient’s clinical records, and relevant information for triage purpose according to Local triage system (LTS), Canadian Triage and Acuity Scale (CTAS), Australasian Triage Scale (ATS), Manchester Triage Scale (MTS) and South African Triage Scale (SATS). Descriptive statistics was used to summarise data and analysis was done using counts, frequencies, median and quartiles. Sensitivity, specificity, positive and negative predictive values were calculated to determine the ability of the triage scales in predicting need for admission and 24hrs mortality. Results: A total of 384 paediatric patients who received triage at EMD-MNH by LTS were studied, their median age was 17 months (Interquartile range 7-36 months) and 211 (54.9%) were male. Using LTS, 67 (17.4%) patients were triaged in emergency (level one), 291 (75.8%) in priority (level 2) and 26 (6.8%) in queue (level 3) categories respectively. Among 67 patients who were triaged level 1 by LTS, only 36 (53.7%) and 25 (37.3%) of them were identified as level one by SATS and MTS respectively. Only 26 (6.8%) were triaged least urgent patients by LTS, SATS identified 21(80.8%) of them as least urgent. There is high sensitivity (80-100%) and specificity (79.9 -80.2%) in predicting mortality while sensitivity for predicting admission was found to be low (27.1- 28.4%) among all triage scales. The urgency to medical care was better predicted by MTS, CTAS, ATS and SATS (all had sensitivity of 100%) compared to LTS (sensitivity 80%). Conclusion and Recommendation: There is performance variations among LTS and other triage scales in predicting need for admission, mortality and waiting time among Paediatric population. Further studies are needed to determine the reliability and validity of the triage tool suitable in our settings.