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

INTRODUCTION: Triage is a crucial process not only to identify sick patients and prioritize prompt management but also to foster efficient resource utilization. In low-and middle-income countries (LMICs) most emergency departments (ED) still have an informal triage process. Although an important ele...

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Autores principales: Singh, Satish Kumar, Sahu, Ankit K., Kumar, Akshay, Murmu, L. R., Bhoi, Sanjeev, Aggarwal, Praveen, Ekka, Meera, Jamshed, Nayer, Gopinath, Bharath, Timilsina, Ghanashyam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9639733/
https://www.ncbi.nlm.nih.gov/pubmed/36353399
http://dx.doi.org/10.4103/jets.jets_146_21
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author Singh, Satish Kumar
Sahu, Ankit K.
Kumar, Akshay
Murmu, L. R.
Bhoi, Sanjeev
Aggarwal, Praveen
Ekka, Meera
Jamshed, Nayer
Gopinath, Bharath
Timilsina, Ghanashyam
author_facet Singh, Satish Kumar
Sahu, Ankit K.
Kumar, Akshay
Murmu, L. R.
Bhoi, Sanjeev
Aggarwal, Praveen
Ekka, Meera
Jamshed, Nayer
Gopinath, Bharath
Timilsina, Ghanashyam
author_sort Singh, Satish Kumar
collection PubMed
description INTRODUCTION: Triage is a crucial process not only to identify sick patients and prioritize prompt management but also to foster efficient resource utilization. In low-and middle-income countries (LMICs) most emergency departments (ED) still have an informal triage process. Although an important element of emergency care, triage research has not been a priority in LMICs, and hence, very few triage systems have been validated. The All India Institute of Medical Sciences (AIIMS) triage protocol or ATP for adult patients was developed by expert consensus at AIIMS using the Delphi method. We attempted a prospective validation of the ATP in terms of mortality and intensive care unit (ICU)/hospital admission at 24 h. METHODS: Patients presenting to the ED, who were 14 years and above were included in the study. The patients were followed up at 24 h and their outcome documented on a standardized data collection form. Mortality and ICU admission were noted at 24 h. RESULTS: A total of 15,505 patients were recruited. After exclusion, among 13,754 patients, 6303 (45.83%) were triaged red and 7451 (54.17%) were triaged yellow. Mortality at 24 h was 10.31% (650) in red triaged patients and 0.35% (26) in yellow triaged patients. The 24-h mortality of red triaged patients was significantly higher (P <0.001) than that of yellow triaged patients. The presence of one or more ATP “Red” criteria was 96.2% (95% confidence interval [CI]: 94.42%–97.47%) sensitive and 56.8% (95% CI: 55.92%–57.63%) specific in predicting 24-h mortality. The sensitivity and specificity of ATP “Red” criteria for 24-h ICU admission were 98.5% (95% CI: 97.7%–99.1%) and 59.6% (95% CI: 58.8%–60.5%), respectively. CONCLUSION: When applied to adult nontrauma patients, ATP had a high accuracy in recognizing sick patients presenting to the ED. A time-tested and validated triage system like ATP may be a good starting point for public hospital EDs in LMICs.
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spelling pubmed-96397332022-11-08 Prospective Validation of a Novel Triage System Developed in a Middle Income Country - AIIMS Triage Protocol Singh, Satish Kumar Sahu, Ankit K. Kumar, Akshay Murmu, L. R. Bhoi, Sanjeev Aggarwal, Praveen Ekka, Meera Jamshed, Nayer Gopinath, Bharath Timilsina, Ghanashyam J Emerg Trauma Shock Original Article INTRODUCTION: Triage is a crucial process not only to identify sick patients and prioritize prompt management but also to foster efficient resource utilization. In low-and middle-income countries (LMICs) most emergency departments (ED) still have an informal triage process. Although an important element of emergency care, triage research has not been a priority in LMICs, and hence, very few triage systems have been validated. The All India Institute of Medical Sciences (AIIMS) triage protocol or ATP for adult patients was developed by expert consensus at AIIMS using the Delphi method. We attempted a prospective validation of the ATP in terms of mortality and intensive care unit (ICU)/hospital admission at 24 h. METHODS: Patients presenting to the ED, who were 14 years and above were included in the study. The patients were followed up at 24 h and their outcome documented on a standardized data collection form. Mortality and ICU admission were noted at 24 h. RESULTS: A total of 15,505 patients were recruited. After exclusion, among 13,754 patients, 6303 (45.83%) were triaged red and 7451 (54.17%) were triaged yellow. Mortality at 24 h was 10.31% (650) in red triaged patients and 0.35% (26) in yellow triaged patients. The 24-h mortality of red triaged patients was significantly higher (P <0.001) than that of yellow triaged patients. The presence of one or more ATP “Red” criteria was 96.2% (95% confidence interval [CI]: 94.42%–97.47%) sensitive and 56.8% (95% CI: 55.92%–57.63%) specific in predicting 24-h mortality. The sensitivity and specificity of ATP “Red” criteria for 24-h ICU admission were 98.5% (95% CI: 97.7%–99.1%) and 59.6% (95% CI: 58.8%–60.5%), respectively. CONCLUSION: When applied to adult nontrauma patients, ATP had a high accuracy in recognizing sick patients presenting to the ED. A time-tested and validated triage system like ATP may be a good starting point for public hospital EDs in LMICs. Wolters Kluwer - Medknow 2022 2022-09-28 /pmc/articles/PMC9639733/ /pubmed/36353399 http://dx.doi.org/10.4103/jets.jets_146_21 Text en Copyright: © 2022 Journal of Emergencies, Trauma, and Shock https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Singh, Satish Kumar
Sahu, Ankit K.
Kumar, Akshay
Murmu, L. R.
Bhoi, Sanjeev
Aggarwal, Praveen
Ekka, Meera
Jamshed, Nayer
Gopinath, Bharath
Timilsina, Ghanashyam
Prospective Validation of a Novel Triage System Developed in a Middle Income Country - AIIMS Triage Protocol
title Prospective Validation of a Novel Triage System Developed in a Middle Income Country - AIIMS Triage Protocol
title_full Prospective Validation of a Novel Triage System Developed in a Middle Income Country - AIIMS Triage Protocol
title_fullStr Prospective Validation of a Novel Triage System Developed in a Middle Income Country - AIIMS Triage Protocol
title_full_unstemmed Prospective Validation of a Novel Triage System Developed in a Middle Income Country - AIIMS Triage Protocol
title_short Prospective Validation of a Novel Triage System Developed in a Middle Income Country - AIIMS Triage Protocol
title_sort prospective validation of a novel triage system developed in a middle income country - aiims triage protocol
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9639733/
https://www.ncbi.nlm.nih.gov/pubmed/36353399
http://dx.doi.org/10.4103/jets.jets_146_21
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