Citation

McKee CH, Heffernan RW, Willenbring BW, Schwartz RB, Liu JM, Colella MR, Lerner EB. Prehosp. Emerg. Care 2019; ePub(ePub): 1-8.

Affiliation

Department of Emergency Medicine , University at Buffalo.

Copyright

(Copyright © 2019, National Association of EMS Physicians, Publisher Informa - Taylor and Francis Group)

DOI

10.1080/10903127.2019.1641579

PMID

31287350

Abstract

Objective. To use a previously published criterion standard to compare the accuracy of four different mass casualty triage systems (SALT, START, Triage Sieve, and CareFlight) when used in an emergency department-based adult population. Methods. We performed a prospective, observational study of a convenience sample of adults aged 18 years or older presenting to a single tertiary care hospital emergency department. A co-investigator with prior EMS experience observed each subject's initial triage in the emergency department and recorded all data points necessary to assign a triage category using each of the four mass casualty triage systems being studied. Subjects' medical records were reviewed after their discharge from the hospital to assign the "correct" triage category using the criterion standard. The four mass casualty triage system assignments were then compared to the "correct" assignment. Descriptive statistics were used to compare accuracy and over- and under-triage rates for each triage system. Results. 125 subjects were included in the study. Of those, 53% were male and 59% were transported by private vehicle. When compared to the criterion standard definitions, SALT was found to have the highest accuracy rate (52%; 95% CI 43-60) compared to START (36%; 95% CI 28-44), CareFlight (36%; 95% CI 28-44), and TriageSieve (37%; 95% CI 28-45). SALT also had the lowest under-triage rate (26%; 95% CI 19-34) compared to START (57%; 95% CI 48-66), CareFlight (58%; 95% CI 49-66), and TriageSieve (58%; 95% CI 49-66). SALT had the highest over-triage rate (22%; 95% CI 14-30) compared to START (7%; 95% CI 3-12), CareFlight (6%; 95% CI 2-11) and TriageSieve (6%; 95% CI 2-10). Conclusion. We found that SALT triage most often correctly triaged adult emergency department patients when compared to a previously published criterion standard. While there are no target under- and over-triage rates that have been published for mass casualty triage, all four systems had relatively high rates of under-triage.

Language: en

Keywords

CareFlight; Disaster; SALT; START; Triage Sieve; accuracy; mass casualty triage