ABSTRACT
AIM: To evaluate performance of a simplified algorithm and treatment instructions for emergency triage assessment and treatment (ETAT) of children presenting to hospital in developing countries. METHODS: All infants aged 7 days to 5 years presenting to an accident and emergency department were simultaneously triaged and assessed by a nurse and a senior paediatrician. Nurse ETAT assessment was compared to standard emergency advanced paediatric life support (APLS) assessment by the paediatrician. Sensitivity, specificity, and predictive values were calculated and appropriateness of nurse treatments was evaluated. RESULTS: The ETAT algorithm as used by nurses identified 731/3837 patients (19.05%); 98 patients (2.6%) were classified as needing emergency treatment and 633 (16.5%) as needing priority assessment. Sensitivity was 96.7% with respect to APLS assessment, 91.7% with respect to all patients given priority by the paediatrician, and 85.7% with respect to patients ultimately admitted. Specificity was 90.6%, 91.0%, and 85.2%, respectively. Nurse administered treatment was appropriate in 94/102 (92.2%) emergency conditions. CONCLUSIONS: The ETAT algorithm and treatment instructions, when carried out by nurses after a short specific training period, performed well as a screening tool to identify priority cases and as a treatment guide for emergency conditions.
Subject(s)
Developing Countries , Emergency Nursing , Practice Guidelines as Topic/standards , Triage/methods , Algorithms , Brazil , Child, Preschool , Clinical Competence , Emergency Nursing/standards , Emergency Service, Hospital , Emergency Treatment , Evaluation Studies as Topic , Humans , Infant , Infant, Newborn , Medical Staff, Hospital/standards , Sensitivity and Specificity , Treatment OutcomeABSTRACT
The clinical records of 87 children with bacterial meningitis treated with antibiotics (group 1) and of 92 treated with antibiotics plus dexamethasone (group 2), admitted to the Instituto Materno Infantil de Pernambuco, Recife, Brazil over 2 consecutive years (1991 and 1992), were analysed. There were no significant differences between treatment groups regarding characteristics on admission except that group 1 were younger. The overall case fatality rate was 19%, with 14% in group 2 and 24% in group 1 (p = 0.09). Rate of discharge without sequelae was 70% in the steroid-treated children and 56% in children treated with antibiotics alone (p = 0.07). Among children aged 6-59 months, those treated with dexamethasone compared with those treated with antibiotics alone had a better case fatality rate (11% vs 25%; p = 0.05) and a better rate of discharge without sequelae (73% vs 52%; p = 0.02). Among the cases with a CSF culture positive for Haemophilus influenzae, 77% were discharged without sequelae in group 2 compared with 51% in group 1 (p = 0.03). The addition of dexamethasone to standard antibiotic treatment improves the outcome of children between 6 and 59 months of age admitted to hospital with a diagnosis of bacterial meningitis.
