Das Präsentationsdiagramm „Massenanfall“ des Manchester-Triage-Systems

Kogej, Monika; Kern, Melina; Tralls, Patric; Berger, Moritz; Gräff, Ingo

doi:10.1007/s10049-021-00937-2

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…Filled symbols secondary triage algorithms. BER Berlin secondary triage algorithm [ 24 ]; JorD Jordanian-German Project Hospital algorithm [ 27 ]; MTS Manchester triage system-MCI module [ 22 ]; ESI emergency severity index [ 23 ]. Empty symbols Primary triage algorithms: PETRA prehospital emergency triage rapid algorithm [ 28 ]; PRIOR primary ranking for initial orientation in emergency services [ 26 ]; mSTaRT modified simple triage and rapid treatment [ 16 ], sensitivity proportion of correct inclusions, specificity proportion of correct exclusions …”

Section: Resultsmentioning

confidence: 99%

“…For the present study, the secondary triage algorithms Manchester triage system (MTS, module MCI [ 22 ]), emergency severity index (ESI [ 23 , 30 ]), the Berlin secondary triage algorithm (BER [ 24 ]), the primary triage algorithms primary ranking for initial orientation in rescue (PRIOR [ 26 ]) and the modified simple triage and rapid treatment (mSTaRT [ 31 ]) as well as two algorithms from an international civil defense project of the BBK with the Hashemite Kingdom of Jordan, “JorD” (intrahospital, supplemental digital content, figure S1 [ 27 ]) and PETRA (prehospital, supplemental digital content, figure S2 [ 28 ]) were used. The aim of this international cooperation was to strengthen Jordanian civil emergency response by providing equipment assistance, training and conceptual advice.…”

Section: Methodsmentioning

confidence: 99%

“…The Youden index [ 32 ] combines sensitivity and specificity in one value and increases with the discriminatory power of the algorithms. BER Berlin secondary triage algorithm [ 24 ], JorD Jordanian-German project hospital algorithm [ 27 ], MTS Manchester triage system MCI module [ 22 ], ESI emergency severity index [ 23 ]. Primary triage algorithms: PETRA prehospital emergency triage rapid algorithm [ 28 ], PRIOR primary ranking for initial orientation in emergency services [ 26 ], mSTaRT modified simple triage and rapid treatment [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…The Manchester triage system (MTS) [ 22 ] and the emergency severity index (ESI) [ 23 ] are used as initial assessment tools in German emergency departments to prioritize patients’ first contact with physicians according to their current treatment urgency [ 3 ]; however, these two systems have not yet been evaluated for their suitability in MCI situations. Algorithms specifically tailored to secondary triage in MCI hardly exist.…”

Section: Introductionmentioning

confidence: 99%

“…The utility of such algorithms has been demonstrated for prehospital emergency medicine [ 13 ]; however, overtriage or undertriage leads to patients not receiving the treatment resources that correspond to their actual treatment urgency [ 9 , 24 , 25 ]. Currently, the MCI module of the MTS [ 22 ] and the Berlin secondary triage algorithm [ 24 ] are the only procedures used in hospitals in Germany. The Berlin algorithm is the only one that has been validated internally and externally to date [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Validation of secondary triage algorithms for mass casualty incidents

Heller,

Neidel,

Klotz

et al. 2023

Anaesthesiologie

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Background In the event of a mass casualty incident (MCI), the situation-related shortage of medical resources does not end when the patients are transported from the scene of the incident. Consequently, an initial triage is required in the receiving hospitals. In the first step, the aim of this study was to create a reference patient vignette set with defined triage categories. This allowed a computer-aided evaluation of the diagnostic quality of triage algorithms for MCI situations in the second step. Methods A total of 250 case vignettes validated in practice were entered into a multistage evaluation process by initially 6 and later 36 triage experts. This algorithm—independent expert evaluation of all vignettes—served as the gold standard for analyzing the diagnostic quality of the following triage algorithms: Manchester triage system (MTS module MCI), emergency severity index (ESI), Berlin triage algorithm (BER), the prehospital algorithms PRIOR and mSTaRT, and two project algorithms from a cooperation between the Federal Office of Civil Protection and Disaster Assistance (BBK) and the Hashemite Kingdom of Jordan—intrahospital Jordanian-German project algorithm (JorD) and prehospital triage algorithm (PETRA). Each patient vignette underwent computerized triage through all specified algorithms to obtain comparative test quality outcomes. Results Of the original 250 vignettes, a triage reference database of 210 patient vignettes was validated independently of the algorithms. These formed the gold standard for comparison of the triage algorithms analyzed. Sensitivities for intrahospital detection of patients in triage category T1 ranged from 1.0 (BER, JorD, PRIOR) to 0.57 (MCI module MTS). Specificities ranged from 0.99 (MTS and PETRA) to 0.67 (PRIOR). Considering Youden’s index, BER (0.89) and JorD (0.88) had the best overall performance for detecting patients in triage category T1. Overtriage was most likely with PRIOR, and undertriage with the MCI module of MTS. Up to a decision for category T1, the algorithms require the following numbers of steps given as the median and interquartile range (IQR): ESI 1 (1–2), JorD 1 (1–4), PRIOR 3 (2–4), BER 3 (2–6), mSTaRT 3 (3–5), MTS 4 (4–5) and PETRA 6 (6–8). For the T2 and T3 categories the number of steps until a decision and the test quality of the algorithms are positively interrelated. Conclusion In the present study, transferability of preclinical algorithm-based primary triage results to clinical algorithm-based secondary triage results was demonstrated. The highest diagnostic quality for secondary triage was provided by the Berlin triage algorithm, followed by the Jordanian-German project algorithm for hospitals, which, however, also require the most algorithm steps until a decision.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Validation of secondary triage algorithms for mass casualty incidents

Heller,

Neidel,

Klotz

et al. 2023

Anaesthesiologie

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Schnelles Handeln

Kegel,

Herrmann,

Welk

2023

Pflege-Pocket Zentrale Notaufnahme

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Validierung innerklinischer Sichtungsalgorithmen für den Massenanfall von Verletzten – eine simulationsbasierte Studie – deutsche Version

et al. 2023

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Zusammenfassung Hintergrund Die situationsbedingte Verknappung medizinischer Ressourcen endet bei einem Massenanfall von Verletzen (MANV) lageabhängig nicht mit dem Abtransport der Patienten von der Einsatzstelle. Folglich ist in den aufnehmenden Kliniken eine Eingangssichtung erforderlich. Ziel dieser Studie war es im ersten Schritt einen Referenz‐Patientenvignettensatz mit definierten Sichtungskategorien zu erstellen. Dies erlaubte im zweiten Schritt, die rechnergestützte Evaluation der diagnostischen Güte klinischer Sichtungsalgorithmen für MANV-Lagen. Methodik In einen mehrstufigen Bewertungsprozess durch zunächst sechs, später 36 Sichtungsexperten gingen 250 in der Übungspraxis validierte Fallvignetten ein. Diese Algorithmen – unabhängige Expertenbewertung aller Vignetten – dienten als Goldstandard für die Analyse der diagnostischen Güte der folgenden innerklinischen Algorithmen: Manchester Triage System (MTS Modul MANV), Emergency severity Index (ESI), Berliner Sichtungsalgorithmus (BER), die prähospitalen Algorithmen PRIOR und mSTaRT, sowie zwei Projektalgorithmen aus einer Kooperation des Bundesamts für Bevölkerungsschutz und Katastrophenhilfe (BBK) mit dem Haschemitischen Königreich Jordanien – innerklinischer jordanisch-deutscher Projektalgorithmus (JorD) und prähospitaler Sichtungsalgorithmus (PETRA). Jede Patientenvignette durchlief computergestützt eine Sichtung durch alle angegeben Algorithmen, um vergleichend die Testgüte für alle Verfahren zu erheben. Ergebnisse Von den ursprünglich 250 Vignetten konnte eine Sichtungsreferenzdatenbank mit 210 Patientenvignetten algorithmenunabhängig validiert werden. Diese bildeten den Goldstandard für den Vergleich der analysierten Sichtungsalgorithmen. Die Sensitivitäten für die innerklinische Detektion von Patienten der Sichtungskategorie I lagen zwischen 1,0 (BER, JorD, PRIOR) und 0,57 (MANV-Modul MTS). Die Spezifitäten lagen zwischen 0,99 (MTS und PETRA) und 0,67 (PRIOR). Gemessen am Youden-Index ergab sich bei BER (0,89) und JorD (0,88) die beste Gesamtperformance für die Detektion von Patienten der Sichtungskategorie I. Eine Übertriage ist am ehesten bei PRIOR, eine Untertriage beim MANV-Modul von MTS zu erwarten. Bis zum Entscheid SK I benötigen die Algorithmen folgende Schrittanzahlen (Median [IQR]): ESI 1 [1–2]; JorD 1 [1–4]; PRIOR 3 [2–4]; BER 3 [2–6]; mSTaRT 3 [3–5]; MTS 4 [4–5]; PETRA 6 [6–8]. Für die SK II und III besteht ein positiver Zusammenhang zwischen der Schrittanzahl bis zum Entscheid und der Testgüte. Schlussfolgerung In der vorliegenden Studie konnte eine Übertragbarkeit prähospitaler algorithmenbasierter Vorsichtungsergebnisse auf die Ergebnisse klinischer Algorithmen gezeigt werden. Die höchste diagnostische Güte für die innerklinischen Sichtung lieferten BER und JorD, die allerdings auch die meisten Algorithmusschritte bis zum Entscheid benötigen.

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Das Präsentationsdiagramm „Massenanfall“ des Manchester-Triage-Systems

Cited by 5 publications

References 10 publications

Validation of secondary triage algorithms for mass casualty incidents

Validation of secondary triage algorithms for mass casualty incidents

Schnelles Handeln

Validierung innerklinischer Sichtungsalgorithmen für den Massenanfall von Verletzten – eine simulationsbasierte Studie – deutsche Version

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