Gyedu Adam, Agbedinu Kwabena, Dalwai Mohammed, Osei-Ampofo Maxwell, Nakua Emmanuel Kweku, Oteng Rockefeller, Stewart Barclay
Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Pan Afr Med J. 2016 Aug 3;24:294. doi: 10.11604/pamj.2016.24.294.8728. eCollection 2016.
The incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained in SATS, as well as to compare triage capabilities between senior medical students and senior house officers to examine the effectiveness of our curriculum for house officer training with regards to triage.
Sixty each of senior medical students and senior house officers who had not undergone specific triage or SATS training were asked to triage 25 previously validated emergency vignettes using the SATS. Estimates of reliability and validity were calculated. Additionally, over- and under-triage, as well as triage performance between the medical students and house officers was assessed against a reference standard.
Fifty-nine senior medical students (98% response rate) and 43 senior house officers (72% response rate) completed the survey (84% response rate overall). A total of 2,550 triage assignments were included in the analysis (59 medical student and 43 house officer triage assignments for 25 vignettes each; 1,475 and 1,075 triage assignments, respectively). Inter-rater reliability was moderate (quadratically weighted κ 0.59 and 0.60 for medical students and house officers, respectively). Triage using SATS performed by these groups had low sensitivity (medical students: 54%, 95% CI 49-59; house officers: 55%, 95% CI 48-60) and moderate specificity (medical students: 84%, 95% CI 82 - 89; house officers: 84%, 95% CI 82 - 97). Both groups under-triaged most 'emergency' level vignette patients (i.e. SATS Red; 80 and 82% for medical students and house officers, respectively). There was no difference between the groups for any metric.
Although the SATS has proven utility in a number of different settings in LMICs, its success relies on its use by trained providers. Given the large and growing burden of emergency conditions, training current and future emergency care providers in triage is imperative.
全球范围内紧急情况的发生率正在上升，尤其是在低收入和中等收入国家（LMICs）。然而，在LMICs中，分诊和急救培训并未得到优先重视。我们旨在评估未接受过南非分诊量表（SATS）专门培训的提供者使用该量表时的可靠性和有效性，并比较高年级医学生和住院医师的分诊能力，以检验我们针对住院医师培训的课程在分诊方面的有效性。
60名未接受过特定分诊或SATS培训的高年级医学生和60名住院医师被要求使用SATS对25个先前已验证的急诊病例进行分诊。计算可靠性和有效性估计值。此外，根据参考标准评估过度分诊和分诊不足情况，以及医学生和住院医师之间的分诊表现。
59名高年级医学生（回复率98%）和43名住院医师（回复率72%）完成了调查（总体回复率84%）。分析共纳入2550次分诊任务（25个病例，医学生和住院医师各有59次和43次分诊任务；分别为1475次和1075次分诊任务）。评分者间信度中等（医学生和住院医师的二次加权κ分别为0.59和0.60）。这些群体使用SATS进行分诊的敏感性较低（医学生：54%，95%CI 49 - 59；住院医师：55%，95%CI 48 - 60），特异性中等（医学生：84%，95%CI 82 - 89；住院医师：84%，95%CI 82 - 97）。两组对大多数“紧急”级病例患者（即SATS红色级）的分诊都不足（医学生和住院医师分别为80%和82%）。两组在任何指标上均无差异。
尽管SATS在LMICs的许多不同环境中已被证明有用，但其成功依赖于经过培训的提供者使用。鉴于紧急情况的负担巨大且不断增加，对当前和未来的急救提供者进行分诊培训势在必行。
