title: Development of a severity of illness scoring system (inpatient triage, assessment and treatment) for resource-constrained hospitals in developing countries.
abstract: OBJECTIVE
  To develop a new paediatric illness severity score, called inpatient triage, assessment and treatment (ITAT), for resource-limited settings to identify hospitalised patients at highest risk of death and facilitate urgent clinical re-evaluation.
  
  
  METHODS
  We performed a nested case-control study at a Malawian referral hospital. The ITAT score was derived from four equally weighted variables, yielding a cumulative score between 0 and 8. Variables included oxygen saturation, temperature, and age-adjusted heart and respiratory rates. We compared the ITAT score between cases (deaths) and controls (discharges) in predicting death within 2 days. Our analysis includes predictive statistics, bivariable and multivariable logistic regression, and calculation of data-driven scores.
  
  
  RESULTS
  A total of 54 cases and 161 controls were included in the analysis. The area under the receiver operating characteristic curve was 0.76. At an ITAT cut-off of 4, the sensitivity, specificity and likelihood ratio were 0.44, 0.86 and 1.70, respectively. A cumulative ITAT score of 4 or higher was associated with increased odds of death (OR 4.80; 95% CI 2.39-9.64). A score of 2 for all individual vital signs was a statistically significant independent predictor of death.
  
  
  CONCLUSIONS
  We developed an inpatient triage tool (ITAT) appropriate for resource-constrained hospitals that identifies high-risk children after hospital admission. Further research is needed to study how best to operationalise ITAT in developing countries.
authors.affiliation: Department of Pediatrics, University of Colorado, Denver, CO, USA. daniel.olson@childrenscolorado.org
authors.forename: Dan
authors.initials: D
authors.lastname: Olson
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Davis
authors.forename: Robert
authors.initials: R
authors.lastname: Milazi
authors.forename: Norman
authors.initials: N
authors.lastname: Lufesi
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Preidis
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: Eric D
authors.initials: ED
authors.lastname: McCollum
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003906:Developing Countries; D005260:Female; D006295:Health Resources; D006339:Heart Rate; D017052:Hospital Mortality; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010100:Oxygen / Q000378:metabolism; D012372:ROC Curve; D012016:Reference Values; D012017:Referral and Consultation; D012119:Respiration; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013696:Temperature; D014218:Triage / Q000379:methods*; D055986:Vital Signs
chemical_list: D010100:Oxygen