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

Vassallo, James; Beavis, John; Smith, Jessi L.; Wallis, Lee

doi:10.1016/j.injury.2017.01.038

Cited by 37 publications

(41 citation statements)

References 19 publications

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“…With the MPTT-24 being developed using logistic regression to determine the optimum thresholds for each of the physiological parameters in the triage tool, it is unlikely that manipulating these further will improve the MPTT-24’s performance. It is likely therefore that we have exhausted the contribution of simple physiological measures to triage patients and that further improvement will require the use of additional variables 15. Alternative assessments including the Shock Index have been suggested as a supplement to the triage process and their performance should be assessed in the civilian setting 14.…”

Section: Discussionmentioning

confidence: 99%

Major incident triage and the evaluation of the Triage Sort as a secondary triage method

Vassallo

Smith

2019

Emerg Med J

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IntroductionA key principle in the effective management of major incidents is triage, the process of prioritising patients on the basis of their clinical acuity. In many countries including the UK, a two-stage approach to triage is practised, with primary triage at the scene followed by a more detailed assessment using a secondary triage process, the Triage Sort. To date, no studies have analysed the performance of the Triage Sort in the civilian setting. The primary aim of this study was to determine the performance of the Triage Sort at predicting the need for life-saving intervention (LSI).MethodsUsing the Trauma Audit Research Network (TARN) database for all adult patients (>18 years) between 2006 and 2014, we determined which patients received one or more LSIs using a previously defined list. The first recorded hospital physiology was used to categorise patient priority using the Triage Sort, National Ambulance Resilience Unit (NARU) Sieve and the Modified Physiological Triage Tool-24 (MPTT-24). Performance characteristics were evaluated using sensitivity and specificity with statistical analysis using a McNemar’s test.Results127 233patients (58.1%) had complete data and were included: 55.6% men, aged 61.4 (IQR 43.1–80.0 years), ISS 9 (IQR 9–16), with 24 791 (19.5%) receiving at least one LSI (priority 1). The Triage Sort demonstrated the lowest accuracy of all triage tools at identifying the need for LSI (sensitivity 15.7% (95% CI 15.2 to 16.2) correlating with the highest rate of under-triage (84.3% (95% CI 83.8 to 84.8), but it had the greatest specificity (98.7% (95% CI 98.6 to 98.8).ConclusionWithin a civilian trauma registry population, the Triage Sort demonstrated the poorest performance at identifying patients in need of LSI. Its use as a secondary triage tool should be reviewed, with an urgent need for further research to determine the optimum method of secondary triage.

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Section: Discussionmentioning

confidence: 99%

Major incident triage and the evaluation of the Triage Sort as a secondary triage method

Vassallo

Smith

2019

Emerg Med J

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“…In keeping with the derivation study, outliers, defined as HR >170 beats per minute, respiratory rate >45 breathes per minute and systolic blood pressure >206 mm Hg were removed 12. Patients were defined as Priority One (P1) if they received one or more life-saving interventions from a previously defined list, derived through international consensus of experts involved in major incident management (see table S1 in the online supplementary file 1).…”

Section: Methodsmentioning

confidence: 99%

“…Within a military population, the MPTT significantly outperformed existing triage tools at predicting need for life-saving intervention, with the lowest rate of undertriage (30.1%) while minimising rates of overtriage (35.2%) 12. However, this was a young population (median 24 years, IQR 21–29 years) sustaining predominantly blast injuries (55% were injured by explosion).…”

Section: Introductionmentioning

confidence: 98%

The civilian validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to primary major incident triage

et al. 2017

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ReuseUnless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. METHODS:A retrospective database review was undertaken of the Trauma Audit Research Network (TARN) database for all adult patients (>18 years) between 2006-2014.Patients were defined as Priority One if they received one or more life-saving interventions from a previously defined list. Using first recorded hospital physiological data, patients were categorised by the MPTT and existing primary physiological triage tools. Only patients with complete physiological data were included in the analysis. Performance characteristics were evaluated using sensitivity, specificity and AUROC. RESULTS:During the study period 218,985 adult patients were included in the TARN database. 127,233 (58.1%) had complete data and were included in the final analysis: 55.6% were male, aged 61. CONCLUSION:The performance characteristics of the MPTT exceed existing major incident triage systems, whilst maintaining an appropriate rate of over-triage and minimising undertriage within the context of predicting the need for a life-saving intervention in a civilian trauma registry population. We recommend that its use within a civilian major incident context be considered.

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“…The Modified Physiological Triage Tool (MPTT) was derived from a military cohort using logistic regression methodology with the purpose of identifying those in need of life-saving intervention 10. Previous studies have successfully validated its use within both a military and civilian environment, and demonstrated superior performance characteristics when compared with existing triage methods 10 11…”

Section: Introductionmentioning

confidence: 99%

The prospective validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to major incident triage

Vassallo

Horne

Smith³

et al. 2017

J R Army Med Corps

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IntroductionTriage is a key principle in the effective management of major incidents. There is limited evidence to support existing triage tools, with a number of studies demonstrating poor performance at predicting the need for a life-saving intervention. The Modified Physiological Triage Tool (MPTT) is a novel triage tool derived using logistic regression, and in retrospective data sets has shown optimum performance at predicting the need for life-saving intervention.Materials and methodsPhysiological data and interventions were prospectively collected for consecutive adult patients with trauma (>18 years) presenting to the emergency department at Camp Bastion, Afghanistan, between March and September 2011. Patients were considered priority 1 (P1) if they received one or more interventions from a previously defined list. Patients were triaged using existing triage tools and the MPTT. Performance was measured using sensitivity and specificity, and a McNemar test with Bonferroni calculation was applied for tools with similar performance.ResultsThe study population comprised 357 patients, of whom 214 (59.9%) were classed as P1. The MPTT (sensitivity: 83.6%, 95% CI 78.0% to 88.3%; specificity: 51.0%, 95% CI 42.6% to 59.5%) outperformed all existing triage tools at predicting the need for life-saving intervention, with a 19.6% absolute reduction in undertriage compared with the existing Military Sieve. The improvement in undertriage comes at the expense of overtriage; rates of overtriage were 11.6% higher with the MPTT than the Military Sieve. Using a McNemar test, a statistically significant (p<0.001) improvement in overall performance was demonstrated, supporting the use of the MPTT over the Military Sieve.Discussion and conclusionsThe MPTT outperforms all existing triage tools at predicting the need for life-saving intervention, with the lowest rates of undertriage while maintaining acceptable levels of overtriage. Having now been validated on both military and civilian cohorts, we recommend that the major incident community consider adopting the MPTT for the purposes of primary triage.

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

Cited by 37 publications

References 19 publications

Major incident triage and the evaluation of the Triage Sort as a secondary triage method

Major incident triage and the evaluation of the Triage Sort as a secondary triage method

The civilian validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to primary major incident triage

The prospective validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to major incident triage

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