Potential benefits of triage for the trauma patient in a Kenyan emergency department

Maria Lampi, Johan P E Junker, John S Tabu, Peter Berggren, Carl-Oscar Jonson, Andreas Wladis, Maria Lampi, Johan P E Junker, John S Tabu, Peter Berggren, Carl-Oscar Jonson, Andreas Wladis

Abstract

Background: Improved trauma management can reduce the time between injury and medical interventions, thus decreasing morbidity and mortality. Triage at the emergency department is essential to ensure prioritization and timely assessment of injured patients. The aim of the present study was to investigate how a lack of formal triage system impacts timely intervention and mortality in a sub-Saharan referral hospital. Further, the study attempts to assess potential benefits of triage towards efficient management of trauma patients in one middle income country.

Methods: A prospective descriptive study was conducted. Adult trauma patients admitted to the emergency department during an 8-month period at Moi Teaching and Referral Hospital in Eldoret, Kenya, were included. Mode of arrival and vital parameters were registered. Variables included in the analysis were Injury Severity Score, time before physician's assessment, length of hospital stay, and mortality. The patients were retrospectively categorized according to the Rapid Emergency Triage and Treatment System (RETTS) from patient records.

Results: A total of 571 patients were analyzed, with a mean Injury Severity Score of 12.2 (SD 7.7) with a mean length of stay of 11.6 (SD 18.3) days. The mortality rate was 1.8%. The results obtained in this study illustrate that trauma patients admitted to the emergency department at Eldoret are not assessed in a timely fashion, and the time frame recommendations postulated by RETTS are not adhered to. Assessment of patients according to the triage algorithm used revealed a significantly higher average Injury Severity Score in the red category than in the other color categories.

Conclusion: The results from this study clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. This is further demonstrated by the retrospective triage classification of patients, which identified patients with high ISS as in urgent need of care. Since no significant difference in to time to assessment regardless of injury severity was observed, the need for a well-functioning triage system is apparent.

Trial registration: ClinicalTrials.gov NCT02303613.

Keywords: Emergency department; Trauma; Triage.

Conflict of interest statement

Ethics approval and consent to participate

The Institutional Research and Ethics Committee (IREC) at MOI University and MOI Teaching and Referral Hospital reviewed and approved the research proposal and has been granted a Formal Approval Number (FAN: IREC 1263). All patient records and data were handled with strict confidentiality by the clinical research team conducting the study as well as the clerk managing the database. Before any data analysis, all patient data were de-identified. The study is part of a project registered at Clinicaltrials.gov (no NCT02303613).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Distribution of patients according to incident type. b Illustrating the patients’ arrival mode to the ED
Fig. 2
Fig. 2
Graph illustrating the Injury Severity Score of patients in relation to RETTS categories. ** denotes p < 0.01, **** denotes p < 0.001

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