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Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2001 Sep;85(3):208–213. doi: 10.1136/adc.85.3.208

Triage in the developing world—can it be done?

M Robertson 1, E Molyneux 1
PMCID: PMC1718916  PMID: 11517102

Abstract

AIM—To assess guidelines for the emergency triage, assessment, and treatment (ETAT) of sick children presenting to hospitals in the developing world. This study pretested the guidelines in Malawi, assessing their performance when used by nurses compared to doctors trained in advanced paediatric life support (APLS).
METHODS—Triage was performed simultaneously by a nurse and assessing doctor on 2281 children presenting to the under 5s clinic. Each patient was allocated one of three priorities, according to the ETAT guidelines. Any variation between nurse and assessor was recorded on the assessment forms.
RESULTS—Nurses identified 92 children requiring emergency treatment and 661 with signs indicating a need for urgent medical assessment. One hundred and forty two (6.2%) had different priorities allocated by the APLS trained doctor, but these children did not tend to need subsequent admission. Eighty five per cent of admissions were prioritised to an emergency or urgent category.
CONCLUSION—Although there are no gold standards for comparison the ETAT guidelines appear to reliably select out the majority of patients requiring admission.



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Selected References

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  1. Banco L., Veltri D. Ability of mothers to subjectively assess the presence of fever in their children. Am J Dis Child. 1984 Oct;138(10):976–978. doi: 10.1001/archpedi.1984.02140480078024. [DOI] [PubMed] [Google Scholar]
  2. Bergeson P. S., Stienfeld H. J. How dependable is palpation as a screening method for fever? Can touch substitute for thermometer readings? Clin Pediatr (Phila) 1974 Apr;13(4):350–351. doi: 10.1177/000992287401300416. [DOI] [PubMed] [Google Scholar]
  3. Berman S., Simoes E. A., Lanata C. Respiratory rate and pneumonia in infancy. Arch Dis Child. 1991 Jan;66(1):81–84. doi: 10.1136/adc.66.1.81. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Blythin P. Management: would you like to wait over there please? Nurs Mirror. 1983 Dec 7;157(23):36–37. [PubMed] [Google Scholar]
  5. Bonadio W. A. Defining fever and other aspects of body temperature in infants and children. Pediatr Ann. 1993 Aug;22(8):467-8, 470-3. doi: 10.3928/0090-4481-19930801-07. [DOI] [PubMed] [Google Scholar]
  6. Campbell H., Byass P., Lamont A. C., Forgie I. M., O'Neill K. P., Lloyd-Evans N., Greenwood B. M. Assessment of clinical criteria for identification of severe acute lower respiratory tract infections in children. Lancet. 1989 Feb 11;1(8633):297–299. doi: 10.1016/s0140-6736(89)91308-1. [DOI] [PubMed] [Google Scholar]
  7. Campbell H., Byass P., O'Dempsey T. J. Effects of body temperature on respiratory rate in young children. Arch Dis Child. 1992 May;67(5):664–664. doi: 10.1136/adc.67.5.664. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cherian T., John T. J., Simoes E., Steinhoff M. C., John M. Evaluation of simple clinical signs for the diagnosis of acute lower respiratory tract infection. Lancet. 1988 Jul 16;2(8603):125–128. doi: 10.1016/s0140-6736(88)90683-6. [DOI] [PubMed] [Google Scholar]
  9. Cioffi J. Decision making by emergency nurses in triage assessments. Accid Emerg Nurs. 1998 Oct;6(4):184–191. doi: 10.1016/s0965-2302(98)90077-7. [DOI] [PubMed] [Google Scholar]
  10. Cooke M. W., Jinks S. Does the Manchester triage system detect the critically ill? J Accid Emerg Med. 1999 May;16(3):179–181. doi: 10.1136/emj.16.3.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Dai Y., Foy H. M., Zhu Z., Chen B., Tong F. Respiratory rate and signs in roentgenographically confirmed pneumonia among children in China. Pediatr Infect Dis J. 1995 Jan;14(1):48–50. doi: 10.1097/00006454-199501000-00010. [DOI] [PubMed] [Google Scholar]
  12. Gadomski A. M., Khallaf N., el Ansary S., Black R. E. Assessment of respiratory rate and chest indrawing in children with ARI by primary care physicians in Egypt. Bull World Health Organ. 1993;71(5):523–527. [PMC free article] [PubMed] [Google Scholar]
  13. Gagliardi L., Rusconi F. Respiratory rate and body mass in the first three years of life. The working party on respiratory rate. Arch Dis Child. 1997 Feb;76(2):151–154. doi: 10.1136/adc.76.2.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. George S., Read S., Westlake L., Williams B., Fraser-Moodie A., Pritty P. Evaluation of nurse triage in a British accident and emergency department. BMJ. 1992 Apr 4;304(6831):876–878. doi: 10.1136/bmj.304.6831.876. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. George S., Read S., Westlake L., Williams B., Pritty P., Fraser-Moodie A. Nurse triage in theory and in practice. Arch Emerg Med. 1993 Sep;10(3):220–228. doi: 10.1136/emj.10.3.220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Gove S., Kumar V. Simple signs and acute respiratory infections. Lancet. 1988 Sep 10;2(8611):626–627. doi: 10.1016/s0140-6736(88)90661-7. [DOI] [PubMed] [Google Scholar]
  17. Gove S., Tamburlini G., Molyneux E., Whitesell P., Campbell H. Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries. WHO Integrated Management of Childhood Illness (IMCI) Referral Care Project. Arch Dis Child. 1999 Dec;81(6):473–477. doi: 10.1136/adc.81.6.473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. John T. J., Cherian T. Determining the respiratory rate in children. World Health Forum. 1991;12(1):74–75. [PubMed] [Google Scholar]
  19. Kresch M. J. Axillary temperature as a screening test for fever in children. J Pediatr. 1984 Apr;104(4):596–599. doi: 10.1016/s0022-3476(84)80558-2. [DOI] [PubMed] [Google Scholar]
  20. Loosemore T. M., Child A. H., Dormandy J. A. Familial abdominal aortic aneurysms. J R Soc Med. 1988 Aug;81(8):472–473. doi: 10.1177/014107688808100820. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Lucero M. G., Tupasi T. E., Gomez M. L., Beltran G. L., Crisostomo A. U., Romano V. V., Rivera L. M. Respiratory rate greater than 50 per minute as a clinical indicator of pneumonia in Filipino children with cough. Rev Infect Dis. 1990 Nov-Dec;12 (Suppl 8):S1081–S1083. [PubMed] [Google Scholar]
  22. Morley C. J. Respiratory rate and pneumonia in infancy. Arch Dis Child. 1991 Aug;66(8):1001–1001. doi: 10.1136/adc.66.8.1001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Morley C. J., Thornton A. J., Fowler M. A., Cole T. J., Hewson P. H. Respiratory rate and severity of illness in babies under 6 months old. Arch Dis Child. 1990 Aug;65(8):834–837. doi: 10.1136/adc.65.8.834. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. O'Dempsey T. J., Laurence B. E., McArdle T. F., Todd J. E., Lamont A. C., Greenwood B. M. The effect of temperature reduction on respiratory rate in febrile illnesses. Arch Dis Child. 1993 Apr;68(4):492–495. doi: 10.1136/adc.68.4.492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. O'Dempsey T. J., Todd J. E. Chest infections in African children. Respiratory rate poor predictor of hypoxaemia. BMJ. 1993 May 15;306(6888):1342–1342. doi: 10.1136/bmj.306.6888.1342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Onyango F. E., Steinhoff M. C., Wafula E. M., Wariua S., Musia J., Kitonyi J. Hypoxaemia in young Kenyan children with acute lower respiratory infection. BMJ. 1993 Mar 6;306(6878):612–615. doi: 10.1136/bmj.306.6878.612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Rusconi F., Castagneto M., Gagliardi L., Leo G., Pellegatta A., Porta N., Razon S., Braga M. Reference values for respiratory rate in the first 3 years of life. Pediatrics. 1994 Sep;94(3):350–355. [PubMed] [Google Scholar]
  28. Simoes E. A., Roark R., Berman S., Esler L. L., Murphy J. Respiratory rate: measurement of variability over time and accuracy at different counting periods. Arch Dis Child. 1991 Oct;66(10):1199–1203. doi: 10.1136/adc.66.10.1199. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Tamburlini G., Di Mario S., Maggi R. S., Vilarim J. N., Gove S. Evaluation of guidelines for emergency triage assessment and treatment in developing countries. Arch Dis Child. 1999 Dec;81(6):478–482. doi: 10.1136/adc.81.6.478. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Wuerz R., Fernandes C. M., Alarcon J. Inconsistency of emergency department triage. Emergency Department Operations Research Working Group. Ann Emerg Med. 1998 Oct;32(4):431–435. doi: 10.1016/s0196-0644(98)70171-4. [DOI] [PubMed] [Google Scholar]

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