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Association between triage level and outcomes at Médecins Sans Frontières trauma hospital in Kunduz, Afghanistan, 2015
  1. Hadjer Latif Daebes1,
  2. Linnea Latifa Tounsi1,
  3. Maximilian Nerlander1,
  4. Martin Gerdin Wärnberg1,2,
  5. Momer Jaweed3,
  6. Bashir Ahmad Mamozai3,
  7. Masood Nasim4,
  8. Miguel Trelles5,
  9. Johan von Schreeb1
  1. 1 Center for Research on Health Care in Disasters, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
  2. 2 Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
  3. 3 Medical Department, Médecins Sans Frontières, Kunduz, Afghanistan
  4. 4 Medical Coordination, Médecins Sans Frontières, Kabul, Afghanistan
  5. 5 Medical Department, Operational Centre Brussels, Doctors without Borders, Bruxelles, Belgium
  1. Correspondence to Hadjer Latif Daebes, Department of Public Health Sciences, Karolinska Institute, 171 77 Stockholm, Sweden; hadjer.daebes{at}vgregion.se

Abstract

Background Five million people die annually due to injuries; an increasing part is due to armed conflict in low-income and middle-income countries, demanding resolute emergency trauma care. In Afghanistan, a low-income country that has experienced conflict for over 35 years, conflict related trauma is a significant public health problem. To address this, the non-governmental organisation Médecins Sans Frontières (MSF) set up a trauma centre in Kunduz (Kunduz Trauma Centre (KTC)). MSF’s standardised emergency operating procedures include the South African Triage Scale (SATS). To date, there are few studies that assess how triage levels correspond with outcome in low-resource conflict settings

Aim This study aims to assess to what extent SATS triage levels correlated to outcomes in terms of hospital admission, intensive care unit (ICU) admission and mortality for patients treated at KTC.

Method and materials This retrospective study used routinely collected data from KTC registries. A total of 17 970 patients were included. The outcomes were hospital admission, ICU admission and mortality. The explanatory variable was triage level. Covariates including age, gender and delay to arrival were used. Logistic regression was used to study the correlation between triage level and outcomes.

Results Out of all patients seeking care, 28.7% were triaged as red or orange. The overall mortality was 0.6%. In total, 90% of those that died and 79% of ICU-admitted patients were triaged as red.

Conclusion The risk of positive and negative outcomes correlated with triage level. None of the patients triaged as green died or were admitted to the ICU whereas 90% of patients who died were triaged as red.

  • emergency care systems
  • emergency department
  • global health
  • Trauma
  • triage

Data availability statement

Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/emermed-2020-209470

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    Data availability statement

    Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available.

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    • Supplementary Data

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    • Supplementary Data

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    Footnotes

    • Handling editor Ellen J Weber

    • Correction notice This article has been corrected since it was published. In the Results section of the Abstract 28.7% were triaged as red or orange instead of 70%.

    • Contributors All the authors have at some point read and revised the article. Coauthors from MSF Afghanistan have additionally been crucial in collecting all data and information. Data were analysed mainly by MGW, LLT and HLD. JvS revised the paper and supervised the entire work with the help of MT, MNe and MGW. JvS acted as the guarantor of the article.

    • Funding MGW, MNe and JvS were funded by a research grant (K919532243) from the National Board of Health and Welfare in Sweden.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.