Research

Vital signs for children at triage: A multicentre validation of the revised South African Triage Scale (SATS) for children

Michèle Twomey, Baljit Cheema, Heloise Buys, Kirsten Cohen, Angela de Sá, Pauline Louw, Majedah Ismail, Heather Finlayson, Charmaine Cunningham, Anthony Westwood

Abstract


Objective. To validate a revised version of the paediatric South African Triage Scale (SATS) against admission as a reference standard and compare the sensitivity of triage using: (i) clinical discriminators; (ii) an age-appropriate physiological composite score; and (iii) a combination of both.

Methods. A prospective cohort study was undertaken validating the revised paediatric SATS against outcome markers of children at six emergency centres during a 2-month period in 2011. The primary outcome marker was the proportion of children admitted. Validity indicators including sensitivity (Se), specificity, positive predictive value and negative predictive value (NPV) were used to estimate the validity. Associated percentages for over-/under-triage were used to further assess practical application of the paediatric SATS.

Results. A total of 2 014 children were included. The percentage of hospital admissions increased with an increase in the level of urgency from 5% in the non-urgent patients to 73% in the emergency patients. The data demonstrated that sensitivity increased substantially when using the SATS, which is a combination of clinical discriminators and the Triage Early Warning Score (TEWS) (Se 91.0%, NPV 95.3%), compared with use of clinical discriminators in isolation (Se 57.1%, NPV 86.3%) or the TEWS in isolation (Se 75.6%, NPV 89.1%).

Conclusion. The results of this study illustrate that the revised paediatric SATS is a safe and robust triage tool.

Authors' affiliations

Michèle Twomey, Division of Emergency Medicine, University of Cape Town

Baljit Cheema, Division of Emergency Medicine, University of Cape Town

Heloise Buys, Red Cross War Memorial Children’s Hospital, Cape Town; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town

Kirsten Cohen, New Somerset Hospital, Cape Town; Division of Emergency Medicine, University of Cape Town

Angela de Sá, Retreat Community Health Centre, Cape Town; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town

Pauline Louw, Paarl Hospital, Paarl, Western Cape; Division of Emergency Medicine, University of Cape Town

Majedah Ismail, Woodstock Community Health Centre, Cape Town; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town

Heather Finlayson, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, Cape Town

Charmaine Cunningham, Milnerton Mediclinic, Cape Town

Anthony Westwood, Provincial Department of Health, Western Cape; Department of Paediatrics, Faculty of Health Sciences, University of Cape Town

Keywords

Emergency Centre, Triage, Paediatrics

Cite this article

South African Medical Journal 2013;103(5):304-308. DOI:10.7196/SAMJ.6877

Article History

Date submitted: 2013-03-08
Date published: 2013-03-22

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