Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
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.
Adam
A
Gyedu
Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Kwabena
K
Agbedinu
Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
Mohammed
M
Dalwai
Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Maxwell
M
Osei-Ampofo
Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Emmanuel Kweku
EK
Nakua
Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Rockefeller
R
Oteng
Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Surgery, University of Washington, Seattle, WA, USA; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
Barclay
B
Stewart
D002983:Clinical Competence; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005869:Ghana; D006801:Humans; D008505:Medical Staff, Hospital / Q000592:standards*; D015588:Observer Variation; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013337:Students, Medical; D011795:Surveys and Questionnaires; D014218:Triage / Q000458:organization & administration*
Ghana; South African triage scale; Triage; diagnostic accuracy