Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda
Background: The Kitovu Fast Triage (KFT) score predicts imminent mortality from mental status, gait and either respiratory rate or oxygen status. As some non-life-threatening conditions require immediate attention, the South African Triage System (SATS) assigns arbitrary rankings of urgency for spec...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | African Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X24000016 |
| _version_ | 1827346226422480896 |
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| author | Jjukira Vianney Immaculate Nakitende Joan Nabiryo Henry Kalema Sylivia Namuleme John Kellett |
| author_facet | Jjukira Vianney Immaculate Nakitende Joan Nabiryo Henry Kalema Sylivia Namuleme John Kellett |
| author_sort | Jjukira Vianney |
| collection | DOAJ |
| description | Background: The Kitovu Fast Triage (KFT) score predicts imminent mortality from mental status, gait and either respiratory rate or oxygen status. As some non-life-threatening conditions require immediate attention, the South African Triage System (SATS) assigns arbitrary rankings of urgency for specific patient presentations. Aim: Establish the feasibility of determining and then comparing the KFT score and explicitly defined SATS urgency rankings. Methods: A computerized proforma used standardized methods of assessing and measuring mental status and gait, and respiratory rate and collected explicitly defined clinical presentations and SATS urgency rankings on 4,842 patients at the time of their arrival to the hospital. Results: 75 % of patients were awake and able to count the months backwards from December to September. Respiratory rates measured by a computer application had no clustering of values or digit preference; however, oximetry failed in 14 % of patients, making the score based on respiratory rate the most practical in our setting. Determining the SATS acuity ranking and both KFT scores usually took <90 s; the commonest complaints were pain, dyspnoea, and fever, which often occurred together; overall 3574 (73.8 %) patients had at least one of these symptoms as did 96.4 % of those with the highest KFT score based on respiratory rate. 12 % of patients with the lowest KFT score based on respiratory rate had one or more very urgent SATS rankings, 52 % of whom had non-severe chest pain. Only 5.7 % of patients complaining of fever had a temperature >38 °C. Conclusion: Whilst the KFT score based on respiratory rate could be rapidly determined in all patients, it identified some patients as low acuity who had very urgent SATS rankings. However, most of these patients had non-severe chest pain, which may not be a very urgent presentation in our setting as ischaemic heart disease remains uncommon in sub-Saharan Africa. |
| first_indexed | 2024-03-07T23:24:05Z |
| format | Article |
| id | doaj.art-b2d18da76aba4d1fb7a06008287e97ae |
| institution | Directory Open Access Journal |
| issn | 2211-419X |
| language | English |
| last_indexed | 2024-03-07T23:24:05Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | African Journal of Emergency Medicine |
| spelling | doaj.art-b2d18da76aba4d1fb7a06008287e97ae2024-02-21T05:24:55ZengElsevierAfrican Journal of Emergency Medicine2211-419X2024-03-011414550Implementation of a fast triage score for patients arriving to a low resource hospital in UgandaJjukira Vianney0Immaculate Nakitende1Joan Nabiryo2Henry Kalema3Sylivia Namuleme4John Kellett5Emergency and out-patient department, Kitovu Hospital, Masaka, UgandaEmergency and out-patient department, Kitovu Hospital, Masaka, UgandaEmergency and out-patient department, Kitovu Hospital, Masaka, UgandaInformation Technology Department, Kitovu Hospital, Masaka, UgandaDirectorate of Nursing, Kitovu Hospital, Masaka, UgandaDepartment of Emergency Medicine, University Hospital Odense, Denmark; Corresponding author at: Ballinaclough, Nenagh, County Tipperary, Ireland.Background: The Kitovu Fast Triage (KFT) score predicts imminent mortality from mental status, gait and either respiratory rate or oxygen status. As some non-life-threatening conditions require immediate attention, the South African Triage System (SATS) assigns arbitrary rankings of urgency for specific patient presentations. Aim: Establish the feasibility of determining and then comparing the KFT score and explicitly defined SATS urgency rankings. Methods: A computerized proforma used standardized methods of assessing and measuring mental status and gait, and respiratory rate and collected explicitly defined clinical presentations and SATS urgency rankings on 4,842 patients at the time of their arrival to the hospital. Results: 75 % of patients were awake and able to count the months backwards from December to September. Respiratory rates measured by a computer application had no clustering of values or digit preference; however, oximetry failed in 14 % of patients, making the score based on respiratory rate the most practical in our setting. Determining the SATS acuity ranking and both KFT scores usually took <90 s; the commonest complaints were pain, dyspnoea, and fever, which often occurred together; overall 3574 (73.8 %) patients had at least one of these symptoms as did 96.4 % of those with the highest KFT score based on respiratory rate. 12 % of patients with the lowest KFT score based on respiratory rate had one or more very urgent SATS rankings, 52 % of whom had non-severe chest pain. Only 5.7 % of patients complaining of fever had a temperature >38 °C. Conclusion: Whilst the KFT score based on respiratory rate could be rapidly determined in all patients, it identified some patients as low acuity who had very urgent SATS rankings. However, most of these patients had non-severe chest pain, which may not be a very urgent presentation in our setting as ischaemic heart disease remains uncommon in sub-Saharan Africa.http://www.sciencedirect.com/science/article/pii/S2211419X24000016TriageEmergency departmentLow resource settingSub-Saharan Africa |
| spellingShingle | Jjukira Vianney Immaculate Nakitende Joan Nabiryo Henry Kalema Sylivia Namuleme John Kellett Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda African Journal of Emergency Medicine Triage Emergency department Low resource setting Sub-Saharan Africa |
| title | Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda |
| title_full | Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda |
| title_fullStr | Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda |
| title_full_unstemmed | Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda |
| title_short | Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda |
| title_sort | implementation of a fast triage score for patients arriving to a low resource hospital in uganda |
| topic | Triage Emergency department Low resource setting Sub-Saharan Africa |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X24000016 |
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