Assessing the reliability and accuracy of nurse triage ratings when using the South African Triage Scale in the Emergency Department of District Headquarter Hospital of Timergara, Pakistan

ObjectiveTo assess inter and intra-rater reliability, as well as accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in the Emergency Department (ED) of District Headquarter (DHQ) Hospital of Timergara, Pakistan.MethodsThis is a cross-sectional study using 42 previously validated paper based vignettes. Fifteen ED nurses assigned triage ratings to each of the 42 vignettes under classroom conditions. Validation of the SATS was done using the vignettes as a reference standard. Graphical displays portrayed rating distribution and validation measures of sensitivity, specificity, overtriage and undertriage across different acuity levels.ResultsThe estimated Quadratically weighted Kappa (QWK) and Interclass Correlation was found to be substantial at 0.77(CI 0.69–0.85). Intra-rater reliability with exact agreement was shown to be 87% (CI 67–100) with one category discrepancy showing 100% agreement. An average sensitivity, 70%; specificity, 97%; overtriage, 14.7% and undertriage, 21.6% was shown. The Graphical displayed showed that Very Urgent, Urgent and routine acuity levels had acceptable levels of overtriage and undertriage.ConclusionThe SATS has been shown to be a reliable triage scale for a developing country such as Pakistan. With accuracy being acceptable in the context of Timergara, we would suggest further validation studies looking at simple ways of validating the triage scale bearing in mind the challenges facing a developing country ED

Reliability and accuracy of the South African triage scale when used by nurses in the emergency department of Timergara hospital Pakistan

Background: Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low- and middle-income countries this strategy is underused, under-resourced and poorly researched. OBJECTIVE: To assess the inter- and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan. METHODS: Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard. RESULTS: Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 - 0.85). The intrarater agreement was also high with 87% exact agreement (95% CI 67 - 100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of over-triage did not exceed the acceptable threshold of 30 - 50%. Under-triage was acceptable for all except emergency cases (66%). CONCLUSION: ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for 'very urgent' and 'routine' cases, importantly, it may under-triage 'emergency' cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed

Implementation of a triage score system in an emergency room in Timergara, Pakistan [Short communication]

Following implementation of the South African Triage Scale (SATS) system in the emergency department (ED) at the District Headquarter Hospital in Timergara, Pakistan, we 1) describe the implementation process, and 2) report on how accurately emergency staff used the system. Of the 370 triage forms evaluated, 320 (86%) were completed without errors, resulting in the correct triage priority being assigned. Fifty completed forms displayed errors, but only 16 (4%) resulted in an incorrect triage priority being assigned. This experience shows that the SATS can be implemented successfully and used accurately by nurses in an ED in Pakistan

Genotypic characterization of rotaviruses and prevalence of serotype-specific serum antibodies in children in Kuwait

There are no data on the serotypes of rotaviruses prevalent in Kuwait, which has a large expatriate population and hence a focal point for transmission of pathogens. The serotype information will contribute to the fund of knowledge on the world epidemiology of rotavirus serotypes and will predict the outcome of vaccination in Kuwait. Of the 75 rotavirus-positive samples from 172 children (aged <5 years) with severe diarrhoea, 69 were genotyped. The distribution of genotypes was G1 (63·8%) followed by G9 (10·2%), G2 (7·3%), G4 (7·3%) and G3 (4·4%). Among the P types, P[8] was the most common type found across all G types. By fluorescent focus neutralization test, serum antibodies to genotypes G1 (94%), G4 (68%) and G9 (46%) were found in 120 other children. These results show that G1 is the predominant serotype in Kuwait and that a vaccine that contains G1 will be most effective