Is the South African Triage Scale valid for use in Afghanistan, Haiti and Sierra Leone?. Issue 2 (15th June 2017)

• Record Type: Journal Article
• Authors: Dalwai, Mohammed; Valles, Pola; Twomey, Michele; Nzomukunda, Yvonne; Jonjo, Prince; Sasikumar, Manoj; Nasim, Masood; Razaaq, Abdul; Gayraud, Olivia; Jecrois, Pierre Ronald; Wallis, Lee; Tayler-Smith, Katie
• Is Part Of: BMJ global health. Volume 2:Issue 2(2017)
• Publication Date: 2017-06-15
• Subjects: Health Systems evaluation -- Trauma; World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2016-000160
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : Objective: To assess the validity of the South African Triage Scale (SATS) in four Médecins Sans Frontières (MSF)-supported emergency departments (ED, two trauma-only sites, one mixed site (both medical and trauma cases) and one paediatric-only site) in Afghanistan, Haiti and Sierra Leone. Methods: This was a retrospective cohort study conducted between June 2013 and June 2014. Validity was assessed by comparing patients' SATS ratings with their final ED outcome (ie, hospital admission, death or discharge). Results: In the two trauma settings, the SATS demonstrated good validity: it accurately predicted an increase in the likelihood of mortality and hospitalisation across incremental acuity levels (p<0.001) and ED outcomes for 'green' and 'red' patients matched the predicted ED outcomes in 84%–99% of cases. In the mixed ED, the SATS was able to predict an incremental increase in hospitalisation (p<0.001) across both trauma and non-trauma cases. In the paediatric-only settings, SATS was able to predict an incremental increase in hospitalisation in the non-trauma cases only (p<0.001). However, 87% (non-trauma) and 94% (trauma) of 'red' patients in the mixed-medical setting were overtriaged and 76% (non-trauma) and 100% (trauma) of 'green' patients in the paediatric settings were undertriaged. Conclusion: The SATS is a valid tool for trauma-only settings in low-resource countries. Its use in mixed settings seems justified, but context-specific assessments would seem prudent. Finally, in paediatric settings with endemic malaria, adding haemoglobin level to the SATS discriminator list may help to improve the undertriage of patients with malaria.