Abstract:
Background: Improved trauma management can reduce the time between injury and medical interventions, thus
decreasing morbidity and mortality. Triage at the emergency department is essential to ensure prioritization
and timely assessment of injured patients. The aim of the present study was to investigate how a lack of
formal triage system impacts timely intervention and mortality in a sub-Saharan referral hospital. Further, the
study attempts to assess potential benefits of triage towards efficient management of trauma patients in one
middle income country.
Methods: A prospective descriptive study was conducted. Adult trauma patients admitted to the emergency
department during an 8-month period at Moi Teaching and Referral Hospital in Eldoret, Kenya, were included.
Mode of arrival and vital parameters were registered. Variables included in the analysis were Injury Severity
Score, time before physician’s assessment, length of hospital stay, and mortality. The patients were
retrospectively categorized according to the Rapid Emergency Triage and Treatment System (RETTS) from
patient records.
Results: A total of 571 patients were analyzed, with a mean Injury Severity Score of 12.2 (SD 7.7) with a
mean length of stay of 11.6 (SD 18.3) days. The mortality rate was 1.8%. The results obtained in this study
illustrate that trauma patients admitted to the emergency department at Eldoret are not assessed in a timely
fashion, and the time frame recommendations postulated by RETTS are not adhered to. Assessment of
patients according to the triage algorithm used revealed a significantly higher average Injury Severity Score in
the red category than in the other color categories.
Conclusion: The results from this study clearly illustrate a lack of correct prioritization of patients in relation
to the need for timely assessment. This is further demonstrated by the retrospective triage classification of
patients, which identified patients with high ISS as in urgent need of care. Since no significant difference in
to time to assessment regardless of injury severity was observed, the need for a well-functioning triage
system is apparent.
