Developing a reference standard for assessing paediatric triage scales in resource poor settings

Abstract

One of the main challenges for emergency healthcare services in low to middle income countries (LMICs) is limited capacity to deal with heavy emergency caseloads. The process of triage is one mechanism for mitigating this challenge. Methods: In a two-round consensus building process (the Delphi process), a panel of emergency centre (EC) experts were asked to independently triage 50 clinical vignettes using one of four acuity levels: emergency (patient to be seen immediately), very urgent (patient to be seen within 10 min), urgent (patient to be seen within 60 min), or routine (patient to be seen within four hours). The vignettes were based on real paediatric EC cases in South Africa. Vignettes that reached a minimum of 80% group consensus for acuity ratings on either round one or two were included in the final set of reference vignettes. Results: Of the 50 vignettes presented to 11 EC experts, in the first round, 80% group consensus on acuity ratings was obtained for 10 (20%) of the vignettes. In the second round, 80% consensus was reached for 30 of the 40 remaining vignettes. Thus, overall, 40 (80%) of the vignettes reached a minimum group consensus of 80% (emergency n = 4; very urgent n = 8; urgent n = 12; routine n = 16). Conclusion: This study demonstrates how context-specific reference vignettes can be developed to provide a cheap, effective, and feasible means by which to evaluate paediatric triage systems in LMICs.

Keywords

• Triage
• Paediatrics
• Validity
• Delphi
• Developing world