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The impact of WHO triage on mortality rate in an emergency department in Erbil, Kurdistan region of Iraq

Soran Ahmad Khdr
Department of Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
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Copyright (c) 2025 Soran Ahmad Khdr (Author)

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Abstract

Background and objective: Triage is a process that includes categorizing patients according to the severity of their illnesses or injuries. This practice offers the potential to enhance the quality of healthcare and reduce the mortality rate. The Integrated Interagency Triage Tool (IITT) is a recently implemented triage system developed by the World Health Organization (WHO). The study aimed to examine the impacts of implementing the triage methods on the death rates of patients visiting the Rizgary Emergency Department.

Methods: This observational study includes the examination and comparing the mortality rate of any patient admitted to Rizgary emergency department in Erbil between January-June 2022, which was before implementing the triage system, and also during that period in 2023 in which the triage system was implemented. For each month, collected data included the number of deaths, admissions, and reasons for death. Cases related to cancer and major trauma were excluded from the study.

Results: Six months after the triage system was implemented, 26,015 patients were admitted, slightly more than the previous year (25,715 patients). The total number of deaths decreased by 41.7% after implementing the triage system. The mean mortality rate decreased from 6.80 deaths per 1,000 in 2022 to 3.94 deaths per 1,000 in 2023, which was statistically significant (P = 0.010).

Conclusion: Implementing the WHO triage system significantly reduced patient mortality in the emergency department by 41.7%, resulting from correct classification and optimal use of available time and resources.

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References

  1. World Health Organization. Emergency care systems framework. https://www.who.int/publications/i/item/who-emergency-care-system-framework. Accessed 2024.
  2. Hinson JS, Martinez DA, Cabral S, George K, Whalen M, Hansoti B, et al. Triage performance in emergency medicine: a systematic review. Annals of emergency medicine. 2019; 74(1):140-52. DOI: 10.1016/j.annemergmed.2018.09.022
  3. Jenson A, Hansoti B, Rothman R, de Ramirez SS, Lobner K, Wallis L. Reliability and validity of emergency department triage tools in low-and middle-income countries: a systematic review. Eur J of Emerg Med. 2018; 25(3):154-60. doi: 10.1097/MEJ.0000000000000445
  4. World Health Organization. Clinical care of severe acute respiratory infections - tool kit. https://www.who.int/publications/i/item/clinical-care-of-severe-acute-respiratory-infections-tool-kit. Accessed 2022.
  5. World Health Organization. Clinical care for severe acute respiratory infection: toolkit: COVID-19 adaptation. World Health Organization; 2022.
  6. Mitchell R, McKup JJ, Banks C, Nason R, O'Reilly G, Kandelyo S, et al. Validity and reliability of the Interagency Integrated Triage Tool in a regional emergency department in Papua New Guinea. Emerg Med Australas. 2022; 34(1):99-107. doi: 10.1111/1742-6723.13877. Epub 2021 Oct 9.
  7. Mitchell R, Sebby W, Piamnok D, Black A, Amono W, Bornstein S, et al. Performance of the Interagency Integrated Triage Tool in a resource-constrained emergency department during the COVID-19 pandemic. Australasian Emergency Care. 2024; 27(1):30-6. https://doi.org/10.1016/j.auec.2023.07.005
  8. Zachariasse JM, van der Hagen V, Seiger N, Mackway-Jones K, van Veen M, Moll HA. Performance of triage systems in emergency care: a systematic review and meta-analysis. BMJ open. 2019; 9(5):e026471. doi: 10.1136/bmjopen-2018-026471.
  9. Tschoellitsch T, Seidl P, Böck C, Maletzky A, Moser P, Thumfart S, et al. Using emergency department triage for machine learning-based admission and mortality prediction. Eur J Emerg Med. 2023; 30(6):408-16. doi: 10.1097/MEJ.0000000000001068. Epub 2023 Aug 14.
  10. Becker JB, Lopes MCBT, Pinto MF, Campanharo CRV, Barbosa DA, Batista REA. Triage at the Emergency Department: association between triage levels and patient outcome. Rev Esc Enferm USP. 2015; 49:0783-9. doi: 10.1590/S0080-623420150000500011
  11. Mitchell R, Bue O, Nou G, Taumomoa J, Vagoli W, Jack S, et al. Validation of the Interagency Integrated Triage Tool in a resource-limited, urban emergency department in Papua New Guinea: a pilot study. The Lancet Regional Health–Western Pacific. 2021; 13. DOI: https://doi.org/10.1016/j.lanwpc.2021.100194
  12. Towns K, Dolo I, Pickering AE, Ludmer N, Karanja V, Marsh RH, et al. Evaluation of emergency care education and triage implementation: an observational study at a hospital in rural Liberia. BMJ open. 2023; 13(5):e067343. doi: 10.1136/bmjopen-2022-067343.
  13. Elbaih AH, Elhadary GK, Elbahrawy MR, Saleh SS. Assessment of the patients’ outcomes after implementation of South African Triage Scale in emergency department, Egypt. Chin J Traumatol. 2022; 25(2):95-101. doi: 10.1016/j.cjtee.2021.10.004.
  14. Dekker-Boersema J, Hector J, Jefferys LF, Binamo C, Camilo D, Muganga G, et al. Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique. Afr J Emerg Med. 2019; 9(4):172-6. doi: 10.1016/j.afjem.2019.05.005. Epub 2019 Jul 2.
How to Cite
Ahmad Khdr, S. . (2025). The impact of WHO triage on mortality rate in an emergency department in Erbil, Kurdistan region of Iraq. Zanco Journal of Medical Sciences (Zanco J Med Sci), 435–440. https://doi.org/10.15218/zjms.2025.046

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