Development of a severity of illness scoring system (inpatient triage, assessment and treatment) for resource‐constrained hospitals in developing countries. Issue 7 (13th June 2013)

• Record Type: Journal Article
• Authors: Olson, Dan; Davis, Nicole L.; Milazi, Robert; Lufesi, Norman; Miller, William C.; Preidis, Geoffrey A.; Hosseinipour, Mina C.; McCollum, Eric D.
• Is Part Of: Tropical medicine & international health. Volume 18:Issue 7(2013:Jul.)
• Page Start: 871
• Page End: 878
• Publication Date: 2013-06-13
• Subjects: Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12137
• Languages: English
• ISSNs: 1360-2276

Abstract

<abstract abstract-type="main" id="tmi12137-abs-0001"> <title>Abstract</title> <sec id="tmi12137-sec-0001" sec-type="section"> <title>Objective</title> <p>To develop a new paediatric illness severity score, called inpatient triage, assessment and treatment (ITAT), for resource‐limited settings to identify hospitalised patients at highest risk of death and facilitate urgent clinical re‐evaluation.</p> </sec> <sec id="tmi12137-sec-0002" sec-type="section"> <title>Methods</title> <p>We performed a nested case–control study at a Malawian referral hospital. The ITAT score was derived from four equally weighted variables, yielding a cumulative score between 0 and 8. Variables included oxygen saturation, temperature, and age‐adjusted heart and respiratory rates. We compared the ITAT score between cases (deaths) and controls (discharges) in predicting death within 2 days. Our analysis includes predictive statistics, bivariable and multivariable logistic regression, and calculation of data‐driven scores.</p> </sec> <sec id="tmi12137-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 54 cases and 161 controls were included in the analysis. The area under the receiver operating characteristic curve was 0.76. At an ITAT cut‐off of 4, the sensitivity, specificity and likelihood ratio were 0.44, 0.86 and 1.70, respectively. A cumulative ITAT score of 4 or higher was associated with increased odds of death (OR 4.80; 95% CI 2.39–9.64). A score of 2 for all individual vital signs was a statistically significant independent predictor of death.</p> </sec> <sec id="tmi12137-sec-0004" sec-type="section"> <title>Conclusions</title> <p>We developed an inpatient triage tool (ITAT) appropriate for resource‐constrained hospitals that identifies high‐risk children after hospital admission. Further research is needed to study how best to operationalise ITAT in developing countries.</p> </sec> </abstract>