Comparison between simple triage and rapid treatment and Taiwan Triage and Acuity Scale for the emergency department triage of victims following an earthquake-related mass casualty incident: a retrospective cohort study

Abstract

Background: Triage plays a crucial role in the emergency department (ED) management of mass casualty incidents (MCIs) when resources are limited. This study aimed to compare the performance of simple triage and rapid treatment (START) with that of the Taiwan Triage and Acuity Scale (TTAS) for the ED triage of victims following an earthquake-related MCI. Methods: We retrospectively reviewed the records of victims presenting at our ED with earthquake-related injuries within 24 h of a large-scale earthquake. TTAS was initially used at our ED for this event, and START was performed by retrospectively reviewing the patient records in a blinded manner. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START and TTAS were determined for predicting ED discharge. Results: We enrolled 105 patients (predominantly women, 60.0%; median age, 45.0 years) in this study; most of them presented with traumatic injuries and were initially triaged as TTAS level III (78.1%), followed by TTAS level II (11.4%). Although the majority of the victims (81.0%) were discharged, four deaths occurred. A moderate agreement in differentiating emergency from nonemergency patients was observed between START and TTAS. Furthermore, both the triage systems showed similar predictions for ED disposition (START AUC/sensitivity/specificity: 0.709/82.35%/ 55.00%; TTAS AUC/sensitivity/specificity: 0.709/90.59%/45.00%). Conclusions: The present study demonstrated that START and TTAS have similar triage accuracy and ability to predict ED disposition. Our findings demonstrate that START may be used as an alternative to TTAS for the ED triage of victims following earthquake-related MCIs.

Impact of the Coronavirus Disease 2019 Pandemic on an Emergency Department Service: Experience at the Largest Tertiary Center in Taiwan

“…The TTAS levels 8–10 are defined as follows – level 1: patient requiring immediate treatment, level 2: patient requiring treatment within 10 minutes, level 3: patient requiring management within 30 minutes, level 4: patient requiring management within one hour, level 5: patient requiring management within two hours. The full criteria for triaging can be found in Table 1 .…”

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

“…Hence, it is argued that START is faster than SALT because START has been developed for resource-limited field triage settings. Prioritizing patients in the immediate category of assisting patients who are more likely to survive than those in the high-risk category has made START faster than other triage systems (Silvestri et al, 2017;Lin et al, 2020). The delay in triage time could be an impact on the patient's outcomes, particularly in critically-ill patients, because it triggers delayed treatments (Claudius et al, 2015).…”

Assessment of earthquake casualties and comparison of accuracy of five injury triage methods: evidence from a retrospective study

“…15 Difficulties experienced in the prospective study of seismic injury triage include the sudden and non-repeatable nature of earthquakes, practical problems of random grouping, ethical issues, logistics and cost. 16 Thus, simulation research and postassessment studies, rather than prospective trials, provide most of the available evidence. In addition, researchers have used data on non-mass casualties, such as estimated relative risk injury registry data, to study ways in which to evaluate the results of mass casualty triage systems.…”