Development of a severity of illness scoring system (inpatient triage, assessment and treatment) for resource-constrained hospitals in developing countries

Trop Med Int Health. 2013 Jul;18(7):871-8. doi: 10.1111/tmi.12137.


Objective: To develop a new paediatric illness severity score, called inpatient triage, assessment and treatment (ITAT), for resource-limited settings to identify hospitalised patients at highest risk of death and facilitate urgent clinical re-evaluation.

Methods: We performed a nested case-control study at a Malawian referral hospital. The ITAT score was derived from four equally weighted variables, yielding a cumulative score between 0 and 8. Variables included oxygen saturation, temperature, and age-adjusted heart and respiratory rates. We compared the ITAT score between cases (deaths) and controls (discharges) in predicting death within 2 days. Our analysis includes predictive statistics, bivariable and multivariable logistic regression, and calculation of data-driven scores.

Results: A total of 54 cases and 161 controls were included in the analysis. The area under the receiver operating characteristic curve was 0.76. At an ITAT cut-off of 4, the sensitivity, specificity and likelihood ratio were 0.44, 0.86 and 1.70, respectively. A cumulative ITAT score of 4 or higher was associated with increased odds of death (OR 4.80; 95% CI 2.39-9.64). A score of 2 for all individual vital signs was a statistically significant independent predictor of death.

Conclusions: We developed an inpatient triage tool (ITAT) appropriate for resource-constrained hospitals that identifies high-risk children after hospital admission. Further research is needed to study how best to operationalise ITAT in developing countries.

Publication types

  • Research Support, American Recovery and Reinvestment Act
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Area Under Curve
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Confidence Intervals
  • Developing Countries*
  • Female
  • Health Resources*
  • Heart Rate
  • Hospital Mortality*
  • Hospitalization
  • Hospitals*
  • Humans
  • Infant
  • Logistic Models
  • Male
  • Odds Ratio
  • Oxygen / metabolism
  • ROC Curve
  • Reference Values
  • Referral and Consultation
  • Respiration
  • Sensitivity and Specificity
  • Severity of Illness Index*
  • Temperature
  • Triage / methods*
  • Vital Signs*


  • Oxygen