Comparing the Accuracy of Three Pediatric Disaster Triage Strategies: A Simulation-Based Investigation

Cicero, Mark X.; Overly, Frank; Brown, Linda; Yarzebski, Jorge; Walsh, Barbara; Shabanova, Veronika; Auerbach, Marc; Riera, Antonio; Adelgais, Kathleen; Meckler, Garth; Cone, David C.; Baum, Carl R.

doi:10.1017/dmp.2015.171

Cited by 18 publications

(36 citation statements)

References 21 publications

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“…The result showed that the highest level of accuracy of the START system was recorded at 94.2% when this model was applied to the medical record data of MCI train victims in Italy. Whereas in another MCI victim medical record analysis from the USA, it was found that the accuracy of the START system was only 44% (Badiali et al, 2017;Cicero et al, 2016;Cone et al, 2011;Jones et al, 2014;Kahn et al, 2009;Lee et al, 2016;Lerner et al, 2010;Silvestri et al, 2017). This indicates that the START triage system is inconsistent in terms of accuracy.…”

Section: Discussionmentioning

confidence: 95%

“…In addition, in a simulated paediatric MCI scenario, medical students achieved a jumpSTART accuracy of 85.7% (Claudius et al, 2015). Moreover, Cicero et al (2016), in their simulated MCIs study among medical students, found that jumpSTART was more accurate than other disaster and MCI triage systems. On the other hand, three mass casualty simulation-based studies identified the range of accuracy of the SALT triage system to be between 70% and 83%.…”

Section: Theme 1: the Accuracy Of Salt And Start Triage Systemsmentioning

confidence: 97%

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The SALT and START Triage System for Classifying Patient Acuity Level: A Systematic Review

Purwadi

Breaden

McCloud

et al. 2021

Nurs. Med. J. Nursing

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Background: Two common triage systems have been widely used in mass casualty incidents (MCIs) and disaster situations, namely START (simple triage algorithm and rapid treatment) and SALT (sort, assess, lifesaving, intervention, and treatment/transport). There is currently controversy regarding the effectiveness of SALT over the START triage system.Purpose: This systematic review aims to compare the accuracy of the SALT and START triage systems in disaster and MCI settings.Methods: The literature was searched using a systematic search strategy for articles published from 2009 to 2020 in the Medline, CINAHL, Web of Science, Scopus, PubMed, ProQuest databases, and the grey literature. This review included simulation-based and medical record-based studies investigating the accuracy and applicability of the SALT and START triage systems in adult and child populations during MCIs and disasters. All types of studies were included. The PRISMA flowchart was used to retain the articles, and the Joanna Briggs Institute critical appraisal tools were used to assess the quality of the reviewed studies.Results: Of 1,450 articles identified in the search, 10 articles were included. It was found that the START triage system had a wide range and inconsistent levels of accuracy (44% to 94.2%) compared to the SALT triage system (70% to 83%). The under-triage error of the START triage system ranged from 2.73% to 20%, which was slightly lower than the SALT triage system (7.6% to 23.3%). The over-triage error of the START triage system (2% to 53%) was slightly higher than the SALT triage system (2% to 22%). However, the time taken to apply START triage system (70 to 72.18 seconds) was faster than for the SALT triage system (78 seconds).Conclusion: The START triage system was simpler and faster than SALT. Conversely, the SALT triage system appeared to be slightly more accurate, more consistent, and had a lower rate of under- and over-triage error than START. It appears that neither the SALT nor the START triage system is superior to the other. Further research is needed to establish the most appropriate disaster and MCI triage system, especially for the Indonesian context.

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Section: Discussionmentioning

confidence: 95%

Section: Theme 1: the Accuracy Of Salt And Start Triage Systemsmentioning

confidence: 97%

The SALT and START Triage System for Classifying Patient Acuity Level: A Systematic Review

Purwadi

Breaden

McCloud

et al. 2021

Nurs. Med. J. Nursing

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“…Few bespoke paediatric triage tools have been derived and there is minimal data from external validations to support the use of one over another on the basis of performance characteristics. 2,15,21-23 Whilst previous studies have compared triage tool performance using either mortality or ISS, neither of these are likely to extrapolate well to the acuity of the patient whilst in the pre-hospital setting. 2-4 In a major incident, the purpose of triage is to prioritise those patients who may benefit from life-saving interventions.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Major Incident Triage Tools in Children – a UK population-based analysis

Vassallo¹,

Chernbumroong

Malik

et al. 2021

Preprint

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Introduction. Triage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study was to perform a comparative analysis of nine adult and paediatric triage tools, including the novel Sheffield Paediatric Triage Tool (SPTT), assessing their ability in identifying patients needing life-saving interventions (LSI). Methods A ten-year retrospective database review of TARN data for paediatric patients (<16years) was performed. Primary outcome was identification of patients receiving one or more LSIs from a previously defined list. Secondary outcomes included mortality and prediction of ISS>15. Primary analysis was conducted on patients with complete pre-hospital physiological data with planned secondary analyses using first recorded physiological data. Performance characteristics were evaluated using sensitivity, specificity, under and over-triage. Results 15133 patients met TARN inclusion criteria. 4962 (32.8%) had complete pre-hospital physiological data and 8255 (54.5%) had complete first recorded data. Male patients predominated (69.5%), sustaining blunt trauma (95.4%) with a median ISS of 9. 875 patients (17.6%) received at least one LSI. The SPTT demonstrated the greatest sensitivity of all triage tools at identifying need for LSI (92.2%) but was associated with the highest rate of over-triage (75.0%). Both the PTT (sensitivity 34.1%) and JumpSTART (sensitivity 45.0%) performed less well at identifying LSI. By contrast, the adult MPTT-24 triage tool had the second highest sensitivity (80.8%) with tolerable rates of over-triage (70.2%). Conclusion The SPTT and MPTT-24 outperform existing paediatric triage tools at identifying those patients requiring LSIs. This may necessitate a change in recommended practice. Further work is needed to determine the optimum method of paediatric major incident triage, but consideration should be given to simplifying major incident triage by the use of one generic tool (the MPTT-24) for adults and children.

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“…The primary objective of this study was to compare triage outcomes of Simple Triage and Rapid Treatment (START 2,16 ), modified START as used by the Fire Department of New York (FDNY; New York USA), 5,9 and CareFlight 9,12 in patients under 16 years of age (Figure 1) to an outcomes-based gold standard using the COT. The secondary outcomes were to determine sensitivity, specificity, under-triage, and over-triage at each level for each MCI triage algorithm along with the overall accuracy of the MCI algorithm.…”

Section: Introductionmentioning

confidence: 99%

Prehospital Disaster Triage Does Not Predict Pediatric Outcomes: Comparing the Criteria Outcomes Tool to Three Mass-Casualty Incident Triage Algorithms

Cicero

Santillanes

Cross

et al. 2021

Prehosp. Disaster med.

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Introduction: It remains unclear which mass-casualty incident (MCI) triage tool best predicts outcomes for child disaster victims. Study Objectives: The primary objective of this study was to compare triage outcomes of Simple Triage and Rapid Treatment (START), modified START, and CareFlight in pediatric patients to an outcomes-based gold standard using the Criteria Outcomes Tool (COT). The secondary outcomes were sensitivity, specificity, under-triage, over-triage, and overall accuracy at each level for each MCI triage algorithm. Methods: Singleton trauma patients under 16 years of age with complete prehospital, emergency department (ED), and in-patient data were identified in the 2007-2009 National Trauma Data Bank (NTDB). The COT outcomes and procedures were translated into ICD-9 procedure codes with added timing criteria. Gold standard triage levels were assigned using the COT based on outcomes, including mortality, injury type, admission to the hospital, and surgical procedures. Comparison triage levels were determined based on algorithmic depictions of the three MCI triage tools. Results: A total of 31,093 patients with complete data were identified from the NTDB. The COT was applied to these patients, and the breakdown of gold standard triage levels, based on their actual clinical outcomes, was: 17,333 (55.7%) GREEN; 11,587 (37.3%) YELLOW; 1,572 (5.1%) RED; and 601 (1.9%) BLACK. CareFlight had the best sensitivity for predicting COT outcomes for BLACK (83% [95% confidence interval, 80%-86%]) and GREEN patients (79% [95% CI, 79%-80%]) and the best specificity for RED patients (89% [95% CI, 89%-90%]). Conclusion: Among three prehospital MCI triage tools, CareFlight had the best performance for correlating with outcomes in the COT. Overall, none of three tools had good test characteristics for predicting pediatric patient needs for surgical procedures or hospital admission.

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Comparing the Accuracy of Three Pediatric Disaster Triage Strategies: A Simulation-Based Investigation

Abstract: Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM.

Cited by 18 publications

References 21 publications

The SALT and START Triage System for Classifying Patient Acuity Level: A Systematic Review

The SALT and START Triage System for Classifying Patient Acuity Level: A Systematic Review

Comparative Analysis of Major Incident Triage Tools in Children – a UK population-based analysis

Prehospital Disaster Triage Does Not Predict Pediatric Outcomes: Comparing the Criteria Outcomes Tool to Three Mass-Casualty Incident Triage Algorithms

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