Validation of the Interagency Integrated Triage Tool in a resource-limited, urban emergency department in Papua New Guinea: a pilot study.

Autor:	Mitchell R; Emergency Physician, Emergency & Trauma Centre, Alfred Health, Melbourne, Australia PhD Candidate, Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia., Bue O; Emergency Physician, Emergency Department, Gerehu General Hospital, Port Moresby, Papua New Guinea., Nou G; Emergency Physician, Emergency Department, Gerehu General Hospital, Port Moresby, Papua New Guinea., Taumomoa J; Clinical Nurse, Emergency Department, Gerehu General Hospital, Port Moresby, Papua New Guinea., Vagoli W; Emergency Physician, Emergency Department, Gerehu General Hospital, Port Moresby, Papua New Guinea., Jack S; Emergency Physician, Emergency Department, Gerehu General Hospital, Port Moresby, Papua New Guinea., Banks C; Emergency Physician, Emergency Department, Townsville University Hospital, Townsville, Australia., O'Reilly G; Emergency Physician and Head of Global Programs, Emergency & Trauma Centre, Alfred Health, Melbourne, Australia, Associate Professor, Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.; Head, Epidemiology and Biostatistics, National Trauma Research Institute, Alfred Health, Melbourne, Australia., Bornstein S; Project lead, Papua New Guinea Emergency Care Capacity Development Remote Training and Support Model Project, Australasian College for Emergency Medicine, Melbourne, Australia., Ham T; Associate Nurse Unit Manager, Emergency Department, St Vincent's Hospital, Melbourne, Australia., Cole T; Emergency Clinical Nurse Specialist, Emergency Department, Townsville University Hospital, Townsville, Australia., Reynolds T; Unit Head, Clinical Services and Systems, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland., Körver S; Global Emergency Care Manager, Australasian College for Emergency Medicine, Melbourne, Australia., Cameron P; Director of Academic Programs, Emergency & Trauma Centre, Alfred Health, Melbourne, Australia,Professor, Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
Jazyk:	angličtina
Zdroj:	The Lancet regional health. Western Pacific [Lancet Reg Health West Pac] 2021 Jul 22; Vol. 13, pp. 100194. Date of Electronic Publication: 2021 Jul 22 (Print Publication: 2021).
DOI:	10.1016/j.lanwpc.2021.100194
Abstrakt:	Background: The Interagency Integrated Triage Tool (IITT) is a three-tier triage system designed for resource-limited emergency care (EC) settings. This study sought to assess the validity and reliability of a pilot version of the tool in an urban emergency department (ED) in Papua New Guinea. Methods: A pragmatic observational study was conducted at Gerehu General Hospital in Port Moresby, commencing eight weeks after IITT implementation. All ED patients presenting within the subsequent two-month period were included. Triage assessments were performed by a variety of ED clinicians, including community health workers, nurses and doctors. The primary outcome was sensitivity for the detection of time-critical illness, defined by ten pre-specified diagnoses. The association between triage category and ED outcomes was examined using Cramer's V correlation coefficient. Reliability was assessed by inter-rater agreement between a local and an experienced, external triage officer. Findings: Among 4512 presentations during the study period, 58 (1.3%) were classified as category one (emergency), 967 (21.6%) as category two (priority) and 3478 (77.1%) as category three (non-urgent). The tool's sensitivity for detecting the pre-specified set of time-sensitive conditions was 70.8% (95%CI 58.2-81.4%), with negative predictive values of 97.3% (95%CI 96.7 - 97.8%) for admission/transfer and 99.9% (95%CI 99.7 - 100.0%) for death. The admission/transfer rate was 44.8% (26/58) among emergency patients, 22.9% (223/976) among priority patients and 2.7% (94/3478) among non-urgent patients (Cramer's V=0.351, p=0.00). Four of 58 (6.9%) emergency patients, 19/976 (2.0%) priority patients and 3/3478 (0.1%) non-urgent patients died in the ED (Cramer's V=0.14, p=0.00). The under-triage rate was 2.7% (94/3477) and the over-triage rate 48.2% (28/58), both within pre-specified limits of acceptability. On average, it took staff 3 minutes 34 seconds (SD 1:06) to determine and document a triage category. Among 70 observed assessments, weighted κ was 0.84 (excellent agreement). Interpretation: The pilot version of the IITT demonstrated acceptable performance characteristics, and validation in other EC settings is warranted. Funding: This project was funded through a Friendship Grant from the Australian Government Department of Foreign Affairs and Trade and an International Development Fund Grant from the Australasian College for Emergency Medicine Foundation. Competing Interests: RM reports grants from the Australian Government Department of Foreign Affairs and Trade and Australasian College for Emergency Medicine Foundation, as well as scholarships from the National Health and Medical Research Council and Monash University, related to this study. GOR reports that he is the recipient of a National Health and Medical Research Council Early Career Research Fellowship. PC reports that he is supported by a Medical Research Future Fund Practitioner Fellowship. (© 2021 Published by Elsevier Ltd.)
Databáze:	MEDLINE
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