Smart triage: triage and management of sepsis in children using the point-of-care Pediatric Rapid Sepsis Trigger (PRST) tool

Alishah Mawji, Edmond Li, Clare Komugisha, Samuel Akech, Dustin Dunsmuir, Matthew O Wiens, Niranjan Kissoon, Nathan Kenya-Mugisha, Abner Tagoola, David Kimutai, Jeffrey N Bone, Guy Dumont, J Mark Ansermino, Alishah Mawji, Edmond Li, Clare Komugisha, Samuel Akech, Dustin Dunsmuir, Matthew O Wiens, Niranjan Kissoon, Nathan Kenya-Mugisha, Abner Tagoola, David Kimutai, Jeffrey N Bone, Guy Dumont, J Mark Ansermino

Abstract

Background: Sepsis is the leading cause of death and disability in children. Every hour of delay in treatment is associated with an escalating risk of morbidity and mortality. The burden of sepsis is greatest in low- and middle-income countries where timely treatment may not occur due to delays in diagnosis and prioritization of critically ill children. To circumvent these challenges, we propose the development and clinical evaluation of a digital triage tool that will identify high risk children and reduce time to treatment. We will also implement and clinically validate a Radio-Frequency Identification system to automate tracking of patients. The mobile platform (mobile device and dashboard) and automated patient tracking system will create a low cost, highly scalable solution for critically ill children, including those with sepsis.

Methods: This is pre-post intervention study consisting of three phases. Phase I will be a baseline period where data is collected on key predictors and outcomes before implementation of the digital triage tool. In Phase I, there will be no changes to healthcare delivery processes in place at the study hospitals. Phase II will involve model derivation, technology development, and usability testing. Phase III will be the intervention period where data is collected on key predictors and outcomes after implementation of the digital triage tool. The primary outcome, time to treatment initiation, will be compared to assess effectiveness of the digital health intervention.

Discussion: Smart technology has the potential to overcome the barrier of limited clinical expertise in the identification of the child at risk. This mobile health platform, with sensors and data-driven applications, will provide real-time individualized risk prediction to rapidly triage patients and facilitate timely access to life-saving treatments for children in low- and middle-income countries, where specialists are not regularly available and deaths from sepsis are common.

Trial registration: Clinical Trials.gov Identifier: NCT04304235, Registered 11 March 2020.

Keywords: Digital triage tool; Resource limited settings; Sepsis; Triage.

Conflict of interest statement

The authors declare that they have no competing interests.

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