Is Overtriage Associated With Increased Mortality? Insights From a Simulation Model of Mass Casualty Trauma Care

Hupert, Nathaniel; Hollingsworth, Eric; Xiong, Wei

doi:10.1097/dmp.0b013e31814cfa54

Cited by 49 publications

(34 citation statements)

References 32 publications

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“…Under certain circumstances, it has been suggested that overtriage may also lead to increased mortality among critically injured patients. [14][15][16] As health care providers look for cost savings, this study provides additional support for using Field Triage guidelines to reduce overtriage (cost savings of $7,264 per patient at a 40% overtriage rate).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Large Cost Savings Realized from the 2006 Field Triage Guideline: Reduction in Overtriage in U.S. Trauma Centers

Faul

Wald²,

Sullivent³

et al. 2011

Prehospital Emergency Care

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Section: Discussionmentioning

confidence: 99%

“…11,13 Excessive overtriage has been associated with additional mortality among severely injured patients. [14][15][16] Because trauma centers exist within large and complex medical systems, the causes of overtriage are often complex and interrelated. Crowding in EDs can result in an overflow of patients that can adversely impact trauma center functioning.…”

mentioning

confidence: 99%

Large Cost Savings Realized from the 2006 Field Triage Guideline: Reduction in Overtriage in U.S. Trauma Centers

Faul

Wald²,

Sullivent³

et al. 2011

Prehospital Emergency Care

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show abstract

“…27 Examples of disaster response-based metrics that are currently being studied include appropriateness of triage level, transportation to a hospital with suitable treatment capability, and time-dependent mortality of victims. [28][29][30] Development of metrics and measurable objectives for disaster response allows EMS leadership to quantify response effectiveness and reproduce best practices.…”

Section: Development Of Performance Metricsmentioning

confidence: 99%

Role of Emergency Medical Services in Disaster Response: Resource Document for the National Association of EMS Physicians Position Statement

Catlett

Jenkins

Millin

2011

Prehospital Emergency Care

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The National Association of EMS Physicians (NAEMSP) advocates for a strong emergency medical services (EMS) role in all phases of disaster management-preparedness, response, and recovery. Emergency medical services administrators and medical directors should play a leadership role in preparedness activities such as training and education, development of performance metrics, establishment of memoranda of understanding (MOUs), and planning for licensure and liability issues. During both the planning and response phases, EMS leadership should advocate for participation in unified command, modified scope of practice appropriate for providers and the event, and expanded roles in community and federal response efforts. To enhance recovery, EMS leadership should strongly advocate for national recognition for EMS efforts and further research into strategies that foster healthy coping techniques and resiliency in the EMS workforce. This resource document will outline the basis for the corresponding NAEMSP position statement on the role of

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“…The impact of over-triage on mortality is less clear but may impact overall survival. [5][6][7] The magnitude of this mistriage threat remains unknown to the large number of communities in the U.S. that utilize START for disaster triage. In addition, no data exist demonstrating that START triage influences decisions regarding which patients should be transported to hospitals first.…”

Section: Importancementioning

confidence: 99%

Does START Triage Work? An Outcomes Assessment After a Disaster

Kahn

Schultz

Miller

et al. 2009

Annals of Emergency Medicine

166

134

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ObjectiveThe mass casualty triage system known as START (Simple Triage and Rapid Treatment) has been widely utilized in the United States since the 1980s. However, no outcomes assessment has been conducted after a disaster to determine whether assigned triage levels match patients' actual clinical status. Researchers hypothesized that START achieves at least 90% sensitivity and specificity for each triage level, and ensures that the most critical patients are transported first to area hospitals. MethodsThe performance of START was evaluated at a train crash disaster in 2003. Patient field triage categories and scene times were obtained from county reports. Patient medical records were then reviewed at all receiving hospitals. Victim arrival times were obtained and correct triage categories determined a priori using a combination of the modified Baxt criteria and hospital admission. Field and outcomes-based triage categories were compared, defining the appropriateness of each triage assignment. ResultsInvestigators reviewed 148 records at 14 receiving hospitals. Field triage designations comprised 22 red (immediate), 68 yellow (delayed), and 58 green (minor) patients. Outcomes-based designations found 2 red, 26 yellow, and 120 green patients. Seventynine patients were over-triaged, three were under-triaged, and 66 patients' outcomes matched their triage level. No triage level met both the 90% sensitivity and 90% specificity requirement set forth in the hypothesis, although red was 100% sensitive (95% CI 15.8-100) and green was 89.3% specific (95% CI 71.8-97.7). The Obuchowski statistic was 0.81, meaning that victims from a higher acuity outcome group had an 81% chance of assignment to a higher acuity triage category. Red patients arrived at hospitals 0.92 hours (95% CI 0.71-1.1) faster than other patients. ConclusionsThis analysis demonstrates poor agreement between triage levels assigned by START at a train crash and a priori outcomes criteria for each level. START ensured acceptable levels of under-triage (100% red sensitivity and 89% green specificity) but incorporated a significant amount of over-triage. START proved useful in prioritizing transport of the most critical patients to area hospitals first.

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Is Overtriage Associated With Increased Mortality? Insights From a Simulation Model of Mass Casualty Trauma Care

Cited by 49 publications

References 32 publications

Large Cost Savings Realized from the 2006 Field Triage Guideline: Reduction in Overtriage in U.S. Trauma Centers

Large Cost Savings Realized from the 2006 Field Triage Guideline: Reduction in Overtriage in U.S. Trauma Centers

Role of Emergency Medical Services in Disaster Response: Resource Document for the National Association of EMS Physicians Position Statement

Does START Triage Work? An Outcomes Assessment After a Disaster

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