Head-to-Head Comparison of Disaster Triage Methods in Pediatric, Adult, and Geriatric Patients - 17/05/13
Address for correspondence: Keith P. Cross, MD, MSRésumé |
Study objective |
A variety of methods have been proposed and used in disaster triage situations, but there is little more than expert opinion to support most of them. Anecdotal disaster experiences often report mediocre real-world triage accuracy. The study objective was to determine the accuracy of several disaster triage methods when predicting clinically important outcomes in a large cohort of trauma victims.
Methods |
Pediatric, adult, and geriatric trauma victims from the National Trauma Data Bank were assigned triage levels, using each of 6 disaster triage methods: simple triage and rapid treatment (START), Fire Department of New York (FDNY), CareFlight, Glasgow Coma Scale (GCS), Sacco Score, and Unadjusted Sacco Score. Methods for approximating triage systems were vetted by subject matter experts. Triage assignments were compared against patient mortality at hospital discharge with area under the receiver operator curve. Secondary outcomes included death in the emergency department, use of a ventilator, and lengths of stay. Subgroup analysis assessed triage accuracy in patients by age, trauma type, and sex.
Results |
In this study, 530,695 records were included. The Sacco Score predicted mortality most accurately, with area under the receiver operator curve of 0.883 (95% confidence interval 0.880 to 0.885), and performed well in most subgroups. FDNY was more accurate than START for adults but less accurate for children. CareFlight was best for burn victims, with area under the receiver operator curve of 0.87 (95% confidence interval 0.85 to 0.89) but mistriaged more salvageable trauma patients to “dead/black” (41% survived) than did other disaster triage methods (≈10% survived).
Conclusion |
Among 6 disaster triage methods compared against actual outcomes in trauma registry patients, the Sacco Score predicted mortality most accurately. This analysis highlighted comparative strengths and weakness of START, FDNY, CareFlight, and Sacco, suggesting areas in which each might be improved. The GCS predicted outcomes similarly to dedicated disaster triage strategies.
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| Supervising editor: Robert A. De Lorenzo, MD, MSM |
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| Author contributions: KPC and MXC conceived and designed the study, obtained institutional review/approval, and prepared the article. KPC performed the data analysis. KPC takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This study was internally funded by the Department of Pediatrics at the University of Louisville School of Medicine. |
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| The American College of Surgeons requires authors to report that any content reproduced from the NTDB remains the full and exclusive copyrighted property of the American College of Surgeons. The College is not responsible for any findings or claims in this work based on the original NTDB data, text, tables, or figures. |
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| Publication date: Available online March 7, 2013. |
Vol 61 - N° 6
P. 668 - juin 2013 Retour au numéro
Article précédent
- Demonstrations of Clinical Initiatives to Improve Palliative Care in the Emergency Department: A Report From the IPAL-EM Initiative
- Tammie Quest, Sherol Herr, Sangeeta Lamba, David Weissman, IPAL-EM Advisory Board
- Systematic Review of Strategies to Manage and Allocate Scarce Resources During Mass Casualty Events
- Justin W. Timbie, Jeanne S. Ringel, D. Steven Fox, Francesca Pillemer, Daniel A. Waxman, Melinda Moore, Cynthia K. Hansen, Ann R. Knebel, Richard Ricciardi, Arthur L. Kellermann
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