Comparative analysis of major incident triage tools in children: a UK population-based analysis.
Emergency Medicine Journal · 2021-10-27 · Observational study
Abstract
INTRODUCTION: Triage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study was to perform a comparative analysis of nine adult and paediatric triage tools, including the novel 'Sheffield Paediatric Triage Tool' (SPTT), assessing their ability in identifying patients needing life-saving interventions (LSIs). METHODS: A 10-year (2008-2017) retrospective database review of the Trauma Audit Research Network (TARN) Database for paediatric patients (<16 years) was performed. Primary outcome was identification of patients receiving one or more LSIs from a previously defined list. Secondary outcomes included mortality and prediction of Injury Severity Score (ISS) >15. Primary analysis was conducted on patients with complete prehospital physiological data with planned secondary analyses using first recorded data. Performance characteristics were evaluated using sensitivity, specificity, undertriage and overtriage. RESULTS: 15 133 patients met TARN inclusion criteria. 4962 (32.8%) had complete prehospital physiological data and 8255 (54.5%) had complete first recorded physiological data. The majority of patients were male (69.5%), with a median age of 11.9 years. The overwhelming majority of patients (95.4%) sustained blunt trauma, yielding a median ISS of 9 and overall, 875 patients (17.6%) received at least one LSI. The SPTT demonstrated the greatest sensitivity of all triage tools at identifying need for LSI (92.2%) but was associated with the highest rate of overtriage (75.0%). Both the Paediatric Triage Tape (sensitivity 34.1%) and JumpSTART (sensitivity 45.0%) performed less well at identifying LSI. By contrast, the adult Modified Physiological Triage Tool-24 (MPTT-24) triage tool had the second highest sensitivity (80.8%) with tolerable rates of overtriage (70.2%). CONCLUSION: The SPTT and MPTT-24 outperform existing paediatric triage tools at identifying those patients requiring LSIs. This may necessitate a change in recommended practice. Further work is needed to determine the optimum method of paediatric major incident triage, but consideration should be given to simplifying major incident triage by the use of one generic tool (the MPTT-24) for adults and children.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Children · Mass casualty triage · Mortality & survival · Triage instruments
Related articles
- Independent application of the Sacco Disaster Triage Method to pediatric trauma patients. (Prehosp Disaster Med, 2012)
- Prehospital Disaster Triage Does Not Predict Pediatric Outcomes: Comparing the Criteria Outcomes Tool to Three Mass-Casualty Incident Triage Algorithms. (Prehosp Disaster Med, 2021)
- A Scoping Review of Pediatric Mass-Casualty Incident Triage Algorithms. (Disaster Med Public Health Prep, 2023)
- Paediatric major incident triage tools for identifying those in need of life-saving interventions (Trauma (SAGE), 2020)
- Comparative Analysis of META and SALT Disaster Triage in an Adult Trauma Population: A Retrospective Observational Study. (Prehosp Disaster Med, 2024)
- Comparison of Outcome Tools Used to Test Mass-Casualty Algorithms in the Pediatric Population. (Prehosp Disaster Med, 2021)