An adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation

  • H Buys
  • R Muloiwa
  • C Westwood
  • D Richardson
  • B Cheema
  • A Westwood


Objective. To evaluate the efficacy of an adapted Emergency Triage Assessment and Treatment (ETAT) tool at a children’s hospital.
Design. A two-armed descriptive study.
Setting. Red Cross War Memorial Children’s Hospital, Cape Town, South Africa.
Methods. Triage data on 1 309 children from October 2007 and July 2009 were analysed. The number of children in each triage category red (emergency), orange (urgent or priority) and green (non-urgent)) and their disposal were evaluated.
Results. The October 2007 series: 902 children aged 5 days - 15 years were evaluated. Their median age was 20 (interquartile range (IQR) 7 -
50) months, and 58.8% (n=530) were triaged green, 37.5% (n=338) orange and 3.8% (n=34) red. Over 90% of children in the green category
were discharged (478/530), while 32.5% of children triaged orange  (110/338) and 52.9% of children triaged red (18/34) were admitted.
There was a significant increase in admission rate for each triage colour change from green through orange to red after adjustment for age
category (risk ratio (RR) 2.6; 95% confidence interval (CI) 2.2 - 3.1).
The July 2009 cohort: 407 children with a median age of 22 months (IQR 7 - 53 months) were enrolled. Twelve children (2.9%) were triaged red, 187 (45.9%) orange and 208 (51.1%) green. A quarter (101/407) of the children triaged were admitted: 91.7% (11/12) from the red category and 36.9% (69/187) from the orange category were admitted, while 89.9% of children in the green category (187/208) were discharged. After adjusting for age category, admissions increased by more than 300% for every change in triage acuity (RR 3.2; 95% CI 2.5 - 4.1).
Conclusions. The adapted ETAT process may serve as a reliable triage tool for busy paediatric medical emergency units in resourceconstrained
countries and could be evaluated further in community emergency settings.

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eISSN: 0256-95749
print ISSN: 2078-5135