Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda

Jjukira Vianney; Immaculate Nakitende; Joan Nabiryo; Henry Kalema; Sylivia Namuleme; John Kellett; Kitovu Hospital Study Group

doi:10.1016/j.afjem.2024.01.001

Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda

Afr J Emerg Med. 2024 Mar;14(1):45-50. doi: 10.1016/j.afjem.2024.01.001. Epub 2024 Jan 24.

Authors

Jjukira Vianney¹, Immaculate Nakitende¹, Joan Nabiryo¹, Henry Kalema², Sylivia Namuleme³, John Kellett⁴; Kitovu Hospital Study Group

Affiliations

¹ Emergency and out-patient department, Kitovu Hospital, Masaka, Uganda.
² Information Technology Department, Kitovu Hospital, Masaka, Uganda.
³ Directorate of Nursing, Kitovu Hospital, Masaka, Uganda.
⁴ Department of Emergency Medicine, University Hospital Odense, Denmark.

Abstract

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.

Keywords: Emergency department; Low resource setting; Sub-Saharan Africa; Triage.