Researchers at Bouaké Teaching Hospital in inland Côte d’Ivoire have developed and internally validated the first African emergency triage score for intracranial suppurative infections, known as TRIAGE-SIC.
The tool was created to address the specific organizational challenges of neurosurgical care in sub-Saharan Africa, where intracranial suppurative infections—including brain abscess, ventriculitis, and subdural or extradural empyema—remain common and are frequently diagnosed late. In these regions, the disease is associated with higher functional morbidity and case fatality rates compared to high-income settings.
Addressing Resource Limitations
The development of TRIAGE-SIC stems from a gap in existing medical instruments. The researchers noted that previously published scores were often developed in populations where resources were not the primary constraint. Such scores frequently rely on variables that are unavailable during emergencies in resource-limited settings, such as specialized markers, bacteriological documentation, or magnetic resonance imaging.
While general-purpose triage systems validated in Africa, including the Cape Triage Score and WHO paediatric triage, have proven useful for predicting in-hospital mortality, they lack the specific neurosurgical granularity required for these infections.
Clinical Application and Goals
The TRIAGE-SIC is designed to assist clinicians, often junior operators, in solving immediate scheduling and resource problems. Rather than predicting long-term outcomes like a three-month probability of death, the score helps determine:
- Whether a patient should occupy the only available operating theatre for the night.
- Whether a patient requires one of the few available close-monitoring beds.
- If a patient can be safely managed on a general ward with antibiotics and reassessed after twelve hours.
This focus is critical because survival for these patients depends on how early a technically simple procedure is performed. The researchers highlight that the primary obstacles to survival in these settings are organizational rather than technical, driven by factors such as prolonged time to consultation and limited critical-care capacity.
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