Major incident triage: Comparative validation using data from 7th July bombings

Challen, Kirsty; Walter, Darren

doi:10.1016/j.injury.2012.06.026

Cited by 34 publications

(42 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11 The major incident setting is no different, and the difficulties in maintaining contemporaneous medical records during a major incident have been described previously. 21,28 The extent of missing data in our study (39.3%) is directly comparable to that observed following the 7 th July bombings (approximately 38.0%).…”

Section: Limitationssupporting

confidence: 82%

“…5,10,11 Following the 7 th July bombings in London, all tools (START, Triage Sieve and Careflight) were shown to have the same performance at identifying priority one patients (50% sensitivity and 100% specificity). 21 Despite being performed on a major incident dataset, data were only available for 50% of the small number of priority one patients, from one hospital (n=4). Additionally, a SBP of 110mmHg was used represent the presence of a palpable pulse when categorising patients using START and Careflight.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Major incident triage: Derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT)

Vassallo

Beavis

Smith

et al. 2017

Injury

View full text Add to dashboard Cite

Major Incident triage: derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT). Background:Triage is a key principle in the effective management at a major incident. There are at least three different triage systems in use worldwide and previous attempts to validate them, have revealed limited sensitivity. Within a civilian adult population, there has been no work to develop an improved system. Methods:A retrospective database review of the UK Joint Theatre Trauma Registry was performed for all adult patients (>18 years) presenting to a deployed Military Treatment Facility between 2006-2013.Patients were defined as Priority One if they had received one or more life-saving interventions from a previously defined list.Using first recorded hospital physiological data (HR/RR/GCS), binary logistic regression models were used to derive optimum physiological ranges to predict need for life-saving intervention. This allowed for the derivation of the Modified Physiological Triage Tool -MPTT (GCS<14, HR>100, 1222). A comparison of the MPTT and existing triage tools was then performed using sensitivities and specificities with 95% confidence intervals. Differences in performance were assessed for statistical significance using a McNemar test with Bonferroni correction. Results:Of 6095 patients, 3654 (60.0%) had complete data and were included in the study, with 1738 (47.6%) identified as priority one. Existing triage tools had a maximum sensitivity of 50.9% (Modified Military Sieve) and specificity of 98.4% (Careflight). The MPTT (sensitivity 69.9%, 95% CI 0.677-0.720, specificity 65.3%, 95% CI 0.632-0.675) showed an absolute increase in sensitivity over existing tools ranging from 19.0% (Modified Military Sieve) to 45.1% (Triage Sieve). There was a statistically significant difference between the performance (p < 0.001) between the MPTT and the Modified Military Sieve. Discussion & Conclusion:The performance characteristics of the MPTT exceed existing major incident triage systems, whilst maintaining an appropriate rate of over-triage and minimising under-triage within the context of predicting the need for a life-saving intervention in a military setting. Further work is required to both prospectively validate this system and to identify its performance within a civilian environment, prior to recommending its use in the major incident setting. Keywords:Triage, Major incidents, life-saving intervention, physiological predictors

show abstract

Section: Limitationssupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Major incident triage: Derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT)

Vassallo

Beavis

Smith

et al. 2017

Injury

View full text Add to dashboard Cite

show abstract

“…However, this standard was indented to be used in quality improvement or research, not in clinical practice. There is evidence that systematic triage of MCI casualties is effective, but firm conclusions cannot be drawn in the absence of appropriate documentation [29]. Lessons learned from international emergency incidents illustrate that health care professionals do not feel sufficiently competent in the area in combination with unfamiliarity with the most common triage protocols [59,146].…”

Section: Discussionmentioning

confidence: 99%

“…This stage represent a very rapid form of triage, entirely conducted according to respiratory rate and capillary refill time or heart rate, in order to classify the patient into triage categories [21,28]. A scientific evaluation of Triage Sieve was conducted retrospectively after the London bombings [29]. In that study, Triage Sieve was compared with START and CareFlight Triage to demonstrate their relative efficiency.…”

Section: Pre-hospital Triagementioning

confidence: 99%

TRIAGE : Management of the trauma patient

Lampi¹

View full text Add to dashboard Cite

Triage, derived from the French word for sorting, aims to assess and prioritize injured patients, regardless of whether the injuries are sustained from everyday road traffic accident with few injured or a mass casualty incident. Triage seeks to provide the greatest benefit to the largest number of casualties in order to minimize morbidity and mortality. Triage in a pre-hospital setting entails management and sorting of patients according to an assessment of medical need, prioritization, and evacuation. In-hospital triage aims to rapidly identify the most injured and ensure timely and appropriate treatment according to the patient's clinical urgency. A number of different systems for performing triage have been established and implemented globally. The methodology is recognized and utilized but there is still a need for an evidence-based strategy to optimize training and the efficacy of the different systems.The main aim of this thesis was to determine triage performance among prehospital personnel and investigate the potential advantage of a triage system for trauma patients. The papers included in this thesis evaluated the triage skills of physicians, pre-hospital personnel, and rescue services personnel by testing their performance before and after an educational intervention. The last paper evaluated potential benefits of using a triage system for trauma patients admitted to the emergency department at MOI Teaching and Referral Hospital in Eldoret, Kenya.The results presented in this thesis illustrate that triage skills are lacking among physicians. Experienced pre-hospital personnel are more skilled in performing triage than physicians. The triage skills of the rescue services personnel improved significantly after the educational intervention. Moreover, the potential benefit to trauma patients of implementing an in-hospital triage system in a resource-poor environment was shown. In conclusion, health care personnel, especially physicians without experience but highly involved in trauma patient management, seem to be in need of triage training. How to train, how to implement, and how to evaluate triage skills must be considered in order to develop effective training. POPULÄRVETENSKAPLIG SAMMANFATTNINGOrdet triage kommer från franskans "sortera" och är ett av det första stegen i omhändertagandet av skadade när det råder resursbrist. Från 1800-talets blodiga slagfält, till dagens skadeplats och akutmottagningar har sättet att triagera patienter utvecklats. Men då, som nu, är grundtanken den samma, att sortera och prioritera de skadade utifrån tillgängliga resurser och patienternas vårdbehov. Följaktligen har begreppet kommit att bli centralt inom ämnet katastrofmedicin. Att avlida till följd av skador i samband med allvarliga händelser men också skador i till exempel vardagstrafiken är ett globalt hälsoproblem. Tiden från olycka till sjukhusbehandling är en viktig och ofta avgörande överlevnadsfaktor för en patient. I det här sammanhanget talas det om "den gyllene timmen", som påvisar vikten av att få ...

show abstract

“…1 A number of studies have shown that existing methods of triage have limited accuracy at predicting the need for life-saving intervention in both the military and civilian environments. 4 Derived specifically for this purpose, the Modified Physiological Triage Tool (MPTT) has shown the greatest sensitivity for predicting the need for lifesaving intervention, with the lowest rates of undertriage and acceptable levels of overtriage in both military and civilian populations. [5][6][7] Respiratory Rate (RR) and Glasgow Coma Scale (GCS) form key components of the MPTT and can both be time consuming to accurately measure,…”

Section: Introductionmentioning

confidence: 99%

2 Major incident triage and the implementation of a new triage tool, the MPTT-24

Vassallo

Smith

2017

Emerg Med J

View full text Add to dashboard Cite

Introduction The Modified Physiological Triage Tool (MPTT) is a recently developed primary triage tool and in comparison with existing tools demonstrates the greatest sensitivity at predicting need for life-saving intervention (LSI) within both military and civilian populations. To improve its applicability, we proposed to increase the upper respiratory rate (RR) threshold to 24 breaths per minute (bpm) to produce the MPTT-24. Our aim was to conduct a feasibility analysis of the proposed MPTT-24, comparing its performance with the existing UK Military Sieve. Method A retrospective review of the Joint Theatre Trauma Registry (JTTR) and Trauma Audit Research Network (TARN) databases was performed for all adult (>18 years) patients presenting between 2006-2013 (JTTR) and 2014 (TARN). Patients were defined as priority one (P1) if they received one or more LSIs. Using first recorded hospital RR in isolation, sensitivity and specificity of the ≥24 bpm threshold was compared with the existing threshold (≥22 bpm) at predicting P1 status. Patients were then categorised as P1 or not-P1 by the MPTT, MPTT-24 and the UK Military Sieve. results The MPTT and MPTT-24 outperformed existing UK methods of triage with a statistically significant (p<0.001) increase in sensitivity of between 25.5% and 29.5%. In both populations, the MPTT-24 demonstrated an absolute reduction in sensitivity with an increase in specificity when compared with the MPTT. A statistically significant difference was observed between the MPTT and MPTT-24 in the way they categorised TARN and JTTR cases as P1 (p<0.001). Conclusions When compared with the existing MPTT, the MPTT-24 allows for a more rapid triage assessment. Both continue to outperform existing methods of primary major incident triage and within the military setting, the slight increase in undertriage is offset by a reduction in overtriage. We recommend that the MPTT-24 be considered as a replacement to the existing UK Military Sieve.

show abstract

Major incident triage: Comparative validation using data from 7th July bombings

Cited by 34 publications

References 12 publications

Major incident triage: Derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT)

Major incident triage: Derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT)

TRIAGE : Management of the trauma patient

2 Major incident triage and the implementation of a new triage tool, the MPTT-24

Contact Info

Product

Resources

About