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

Abstract

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.

Triage and the Modified Physiological Triage Tool-24 (MPTT-24)

“…When the performance of existing methods of triage such as the Major Incident Medical Management and Support (MIMMS) Triage Sieve and the UK Defence Medical Services (DMS) Military Sieve is analysed, it is evident that they do not accurately identify those in need of life-saving intervention 8 9. Indeed, this is not a problem unique to UK triage tools; both the START (USA) and Careflight (Australia) tools were found to be just as inaccurate following the London 7/7 bombings 10.…”

“…Combining elements of civilian practice (the traditional MIMMS Triage Sieve) and the existing DMS Military Sieve, the NARU sieve now includes an assessment of conscious level and catastrophic haemorrhage 11 12. Unfortunately, a number of military and civilian trauma registry studies have shown that the Military Sieve (essentially analogous to the NARU sieve) also lacks the accuracy to adequately identify those needing a life-saving intervention 8 13…”

“…In both military and civilian trauma populations, the MPTT demonstrated the greatest sensitivity, correlating with the lowest rates of undertriage (i.e, missing patients in need of life-saving interventions). However, within both populations, the improvement in sensitivity came with a reduction in specificity and had the highest rates of overtriage (classifying patients who did not require a life-saving intervention as priority 1) 8 9 13…”

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

“…Patients were assumed to be non-ambulant due to the nature of the TARN database and its inclusion criteria. 6 Patients were defined as priority one (P1) if they had received one or more life-saving interventions from a previously defined list, derived through international consensus of experts involved in major incident management (Figure 1). 14 Using first recorded hospital RR in isolation, the sensitivity and specificity of the ≥24 breaths per minute threshold were compared with the existing threshold (≥22 breaths per minute) at predicting P1 status.…”

“…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,…”