RESUMO
OBJECTIVES: Acute triage is needed to prioritize care and achieve optimal resource allocation in busy emergency departments. The main objective is to compare the FRench Emergency Nurse Classification in Hospital scale (FRENCH) to the American scale Emergency Severity Index (ESI). Secondary objectives are to compare for each scale the over and under-triage, the triage matching to the gold standard and the inter-individual sorting reproducibility between the nurses. METHODS: This is a prospective observational study conducting among the nursing staffs and nursing students, selected from Caen University College Hospital and Lisieux Hospital Center emergency departments between two months. Each group individually rank 60 referent clinical cases composed by scales designers. An assessment of scale practicality is collected after for each tool. The collected parameters are analyzed by a Cohen kappa concordance test (κ). RESULTS: With 8151 triage results of gold standard scenarios sorting in two scales by the same nurses, the FRENCH scale seems to give better triage results than the US ESI scale (nurse: FRENCH 60% and ESI 53%, p = 0.003 ; nursing students: FRENCH 49% and ESI 42%, p < 0.001). In the two groups ESI has also a big tendency to under-sort (p = 0.01), particularly for the most severe patients (p < 0.01). The interobserver sorting concordance for any experience gives good results for the FRENCH and the ESI without any difference (nurses : FRENCH KPQ=0.72 ESI KPQ=0.78; p = 0.32 ; students KPQ=0.44 KPQ=0.55; p = 0.22). CONCLUSION: The ESI and FRENCH scales comparison on 8151 sorting results shows direct validity in favor of FRENCH one and similar interobserver agreement for both scales.
Assuntos
Serviço Hospitalar de Emergência , Triagem , Humanos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Triagem/métodos , Estudos ProspectivosRESUMO
PIP: This document provides detailed information on the health facilities and manpower of the Cap-Vert region of Senegal. The Cap-Vert region is the most developed of Senegal and contains .3% of the territory but 21% of the population. Its 1,200,000 residents have much higher incomes and literacy rates than are found in the remainder of the country. Cap-Vert is divided into 3 health areas with 18 auxiliary health posts or dispensaries and 30 municipal health posts and dispensaries, in addition to 2 Red Cross posts, 10 health services affiliated with religious groups, and 13 other posts. Each center has at least 1 nurse and 18 physicians are attached to them as a group. Their function is to provide general medical care. 59 private general medical practitioners and 39 specialists also offer services. The region contains state, municipal and private hospitals. Preventive facilities include 23 maternal-child health centers; the institute of social hygiene, which provides tuberculosis and venereal disease surveillance and ambulatory care for some ailments; a service for epidemic diseases; medical care for schools; the bureau of health education; the Pasteur Institute which provides laboratory tests, produces vaccines, and conducts research and teaching programs; and municipal health services. Drugs are provided without charge in public hospitals but not in private facilities. The density of curative and preventive services is the greatest in Senegal, but it does not compensate for the budgetary shortages and the problems created by a suboptimal standard of personnel. Availability of health care varies widely according to socioeconomic level and ability to pay. The private system covers about 400,000 persons, the semipublic system based on Catholic-run health posts covers about 450,000 persons, and the state system covers about 350,000 persons totally and another 150,000 or so who also use the private services intermittently. The share of health costs assumed by the recipients of health care in the form of fees and payments is helpful although it falls far short of the total and should perhaps be increased.^ieng