Prioritizing the Care of Critically Ill Children in South Africa: How Does SCREEN Perform Against Other Triage Tools?
OBJECTIVE
Childhood mortality remains unacceptably high. In low-resource settings, children with critical illness often present for care. Current triage strategies are time consuming and require trained health care workers. To address this limitation, our team developed a simple subjective tool, SCREEN (Sick Children Require Emergency Evaluation Now), which is easy to administer, to identify critically ill children. This article presents the development of the SCREEN program and evaluates its performance when compared with other commonly implemented triage tools in low-resource settings.


METHODS
We measured the sensitivity and specificity of SCREEN, to identify critically ill children, compared with 4 other previously validated triage tools: the Integrated Management of Childhood Illnesses, the Pediatric Early Warning, the Pediatric South African Triage Scale, and the World Health Organization Emergency Triage Treatment Tool.


RESULTS
SCREEN has high sensitivity (100%-98.73%; P < 0.001) and specificity (64.41%-50.71%; P < 0.001) when compared with other validated triage tools.


CONCLUSIONS
The SCREEN tool may offer a simple and effective method to identify critically ill children in low-resource environments.
From the Johns Hopkins University, Baltimore, MD.|Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
Bhakti
B
Hansoti
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
Peter
P
Hodkinson
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
Lee
L
Wallis
D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006282:Health Personnel; D006295:Health Resources; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D012680:Sensitivity and Specificity; D013019:South Africa; D014218:Triage / Q000379:methods*