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Two simple replacements for the Triage Early Warning Score to facilitate the South African Triage Scale in low resource settings

BACKGROUND: The South African Triage Scale (SATS) requires the calculation of the Triage Early Warning Score (TEWS), which takes time and is prone to error. AIM: to derive and validate triage scores from a clinical database collected in a low-resource hospital in sub-Saharan Africa over four years a...

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Autores principales: Wasingya-Kasereka, Lucien, Nabatanzi, Pauline, Nakitende, Immaculate, Nabiryo, Joan, Namujwiga, Teopista, Kellett, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: African Federation for Emergency Medicine 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806646/
https://www.ncbi.nlm.nih.gov/pubmed/33489734
http://dx.doi.org/10.1016/j.afjem.2020.11.007
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author Wasingya-Kasereka, Lucien
Nabatanzi, Pauline
Nakitende, Immaculate
Nabiryo, Joan
Namujwiga, Teopista
Kellett, John
author_facet Wasingya-Kasereka, Lucien
Nabatanzi, Pauline
Nakitende, Immaculate
Nabiryo, Joan
Namujwiga, Teopista
Kellett, John
author_sort Wasingya-Kasereka, Lucien
collection PubMed
description BACKGROUND: The South African Triage Scale (SATS) requires the calculation of the Triage Early Warning Score (TEWS), which takes time and is prone to error. AIM: to derive and validate triage scores from a clinical database collected in a low-resource hospital in sub-Saharan Africa over four years and compare them with the ability of TEWS to triage patients. METHODS: A retrospective observational study carried out in Kitovu Hospital, Masaka, Uganda as part of an ongoing quality improvement project. Data collected on 4482 patients was divided into two equal cohorts: one for the derivation of scores by logistic regression and the other for their validation. RESULTS: Two scores identified the largest number of patients with the lowest in-hospital mortality. A score based on oxygen saturation, mental status and mobility had a c statistic for discrimination of 0.83 (95% CI 0.079–0.87) in the derivation, and 0.81 (95% CI 0.77–0.86) in the validation cohort. Another score based on respiratory rate, mental status and mobility had a c statistic of 0.82 (95% CI 0.078–0.87) in the derivation, and 0.81 (95% CI 0.77–0.86) in the validation cohort. The oxygen saturation-based score of zero points identified 51% of patients in the derivation cohort who had in-hospital mortality rate of 0.5%, and 49% of patients in the validation cohort who had in-hospital mortality of 1.0%. A respiratory rate-based score of zero points identified 45% in the derivation cohort who had in-hospital mortality rate of 0.5%, and 44% of patients in the validation cohort who had in-hospital mortality of 0.8%. Both scores had comparable performance to TEWS. CONCLUSION: Two easy to calculate scores have comparable performance to TEWS and, therefore, could replace it to facilitate the adoption of SATS in low-resource settings.
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spelling pubmed-78066462021-01-22 Two simple replacements for the Triage Early Warning Score to facilitate the South African Triage Scale in low resource settings Wasingya-Kasereka, Lucien Nabatanzi, Pauline Nakitende, Immaculate Nabiryo, Joan Namujwiga, Teopista Kellett, John Afr J Emerg Med Original Article BACKGROUND: The South African Triage Scale (SATS) requires the calculation of the Triage Early Warning Score (TEWS), which takes time and is prone to error. AIM: to derive and validate triage scores from a clinical database collected in a low-resource hospital in sub-Saharan Africa over four years and compare them with the ability of TEWS to triage patients. METHODS: A retrospective observational study carried out in Kitovu Hospital, Masaka, Uganda as part of an ongoing quality improvement project. Data collected on 4482 patients was divided into two equal cohorts: one for the derivation of scores by logistic regression and the other for their validation. RESULTS: Two scores identified the largest number of patients with the lowest in-hospital mortality. A score based on oxygen saturation, mental status and mobility had a c statistic for discrimination of 0.83 (95% CI 0.079–0.87) in the derivation, and 0.81 (95% CI 0.77–0.86) in the validation cohort. Another score based on respiratory rate, mental status and mobility had a c statistic of 0.82 (95% CI 0.078–0.87) in the derivation, and 0.81 (95% CI 0.77–0.86) in the validation cohort. The oxygen saturation-based score of zero points identified 51% of patients in the derivation cohort who had in-hospital mortality rate of 0.5%, and 49% of patients in the validation cohort who had in-hospital mortality of 1.0%. A respiratory rate-based score of zero points identified 45% in the derivation cohort who had in-hospital mortality rate of 0.5%, and 44% of patients in the validation cohort who had in-hospital mortality of 0.8%. Both scores had comparable performance to TEWS. CONCLUSION: Two easy to calculate scores have comparable performance to TEWS and, therefore, could replace it to facilitate the adoption of SATS in low-resource settings. African Federation for Emergency Medicine 2021-03 2021-01-06 /pmc/articles/PMC7806646/ /pubmed/33489734 http://dx.doi.org/10.1016/j.afjem.2020.11.007 Text en © 2018 Published by Elsevier Ltd. CC BY-NC-ND 4.0. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Wasingya-Kasereka, Lucien
Nabatanzi, Pauline
Nakitende, Immaculate
Nabiryo, Joan
Namujwiga, Teopista
Kellett, John
Two simple replacements for the Triage Early Warning Score to facilitate the South African Triage Scale in low resource settings
title Two simple replacements for the Triage Early Warning Score to facilitate the South African Triage Scale in low resource settings
title_full Two simple replacements for the Triage Early Warning Score to facilitate the South African Triage Scale in low resource settings
title_fullStr Two simple replacements for the Triage Early Warning Score to facilitate the South African Triage Scale in low resource settings
title_full_unstemmed Two simple replacements for the Triage Early Warning Score to facilitate the South African Triage Scale in low resource settings
title_short Two simple replacements for the Triage Early Warning Score to facilitate the South African Triage Scale in low resource settings
title_sort two simple replacements for the triage early warning score to facilitate the south african triage scale in low resource settings
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806646/
https://www.ncbi.nlm.nih.gov/pubmed/33489734
http://dx.doi.org/10.1016/j.afjem.2020.11.007
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