Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-24T00:02:12.143Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparing the Accuracy of Three Pediatric Disaster Triage Strategies: A Simulation-Based Investigation

Published online by Cambridge University Press:  08 January 2016

Mark X. Cicero ,
Frank Overly Open the ORCID record for Frank Overly [Opens in a new window] ,
Linda Brown ,
Jorge Yarzebski ,
Barbara Walsh ,
Veronika Shabanova ,
Marc Auerbach ,
Antonio Riera ,
Kathleen Adelgais  and
Garth Meckler
...Show all authors
Mark X. Cicero*
Affiliation:
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
Frank Overly
Affiliation:
Department of Emergency Medicine, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island
Linda Brown
Affiliation:
Department of Emergency Medicine, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island
Jorge Yarzebski
Affiliation:
Department of Medical Education, University of Massachusetts School of Medicine, Worcester, Massachusetts
Barbara Walsh
Affiliation:
Department of Pediatrics, University of Massachusetts School of Medicine, Worcester, Massachusetts
Veronika Shabanova
Affiliation:
Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
Marc Auerbach
Affiliation:
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
Antonio Riera
Affiliation:
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
Kathleen Adelgais
Affiliation:
Department of Emergency Medicine, Children’s Hospital Colorado, Aurora, Colorado
Garth Meckler
Affiliation:
Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada.
David C. Cone
Affiliation:
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
Carl R. Baum
Affiliation:
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
*
Correspondence and reprint requests to Mark X. Cicero, Department of Emergency Medicine, Yale School of Medicine, 100 York Street Suite 1F, New Haven, CT 06511 (e-mail: [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes.

Methods

We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients’ expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased).

Results

There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (P<0.001; OR [odds ratio]: 2.03; interquartile range [IQR]: 1.30, 3.17) or CDM (P=0.02; OR: 1.76; IQR: 1.10, 2.82). JumpSTART outperformed Smart for RED patients (P=0.05; OR: 1.48; IQR: 1.01,2.17), and outperformed both Smart (P<0.001; OR: 3.22; IQR: 1.78,5.88) and CDM (P<0.001; OR: 2.86; IQR: 1.53,5.26) for YELLOW patients. Furthermore, JumpSTART outperformed CDM for BLACK patients (P=0.01; OR: 5.55; IQR: 1.47, 20.0).

Conclusion

Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM. (Disaster Med Public Health Preparedness. 2016;10:253–260)

Keywords

triageemergency respondersmass casualty incidentsvulnerable populations
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Issue 2 , April 2016 , pp. 253 - 260
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Mace, S, Jones, J, Bern, A. An analysis of Disaster Medical Assistance Team (DMAT) deployments in the United States. Prehosp Emerg Care. 2007;11(1):30-35. http://dx.doi.org/10.1080/10903120601023396.Google Scholar
2. Lerner, EB, Cone, DC, Weinstein, ES, et al. Mass casualty triage: an evaluation of the science and refinement of a national guideline. Disaster Med Public Health Prep. 2011;5(2):129-137. http://dx.doi.org/10.1001/dmp.2011.39.CrossRefGoogle ScholarPubMed
3. Baxt, WG, Jones, G, Fortlage, D. The trauma triage rule: a new, resource-based approach to the prehospital identification of major trauma victims. Ann Emerg Med. 1990;19(12):1401-1406. http://dx.doi.org/10.1016/S0196-0644(05)82608-3.Google Scholar
4. Seidel, JS, Henderson, DP, Ward, P, et al. Pediatric prehospital care in urban and rural areas. Pediatrics. 1991;88(4):681-690.Google Scholar
5. Sutton, D, Stanley, P, Babl, F, et al. Preventing or accelerating emergency care for children with complex healthcare needs. Arch Dis Child. 2008;93(1):17-22. http://dx.doi.org/10.1136/adc.2007.117960.Google Scholar
6. Richard, J, Osmond, MH, Nesbitt, L, et al. Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system. CJEM. 2006;8(1):6-12.CrossRefGoogle Scholar
7. Romig, L. Pediatric triage. A system to JumpSTART your triage of young patients at MCIs. JEMS. 2002;27(7):52-58. 60-53.Google Scholar
8. Cone, DC, Serra, J, Kurland, L. Comparison of the SALT and Smart triage systems using a virtual reality simulator with paramedic students. Eur J Emerg Med. 2011;18(6):314-321. http://dx.doi.org/10.1097/MEJ.0b013e328345d6fd.Google Scholar
9. SALT mass casualty triage: concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association. Disaster Med Public Health Prep. 2008;2(4):245-246. http://dx.doi.org/10.1097/DMP.0b013e31818d191e.Google Scholar
10. Lerner, E, Schwartz, R, Coule, P, et al. Mass casualty triage: an evaluation of the data and development of a proposed national guideline. Disaster Med Public Health Prep. 2008;2: (S1) (suppl 1):S25-S34. http://dx.doi.org/10.1097/DMP.0b013e318182194e.CrossRefGoogle ScholarPubMed
11. Emerman, C, Shade, B, Kubincanek, J. A comparison of EMT judgment and prehospital trauma triage instruments. J Trauma. 1991;31(10):1369-1375. http://dx.doi.org/10.1097/00005373-199110000-00009.Google Scholar
12. Wallis, LA, Carley, S. Comparison of paediatric major incident primary triage tools. Emerg Med J . 2006;23(6):475-478. http://dx.doi.org/10.1136/emj.2005.032672.Google Scholar
13. Jenkins, J, McCarthy, M, Sauer, L, et al. Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med. 2008;23(1):3-8. http://dx.doi.org/10.1017/S1049023X00005471.Google Scholar
14. Cross, KP, Cicero, MX. Head-to-head comparison of disaster triage methods in pediatric, adult, and geriatric patients. Ann Emerg Med. 2013;61(6):668-676.e7. http://dx.doi.org/10.1016/j.annemergmed.2012.12.023.Google Scholar
15. Lerner, E, Schwartz, R, Coule, P, et al. Use of SALT triage in a simulated mass-casualty incident. Prehosp Emerg Care. 2010;14(1):21-25. http://dx.doi.org/10.3109/10903120903349812.Google Scholar
16. Sacco, W, Navin, D, Waddell, RK II, et al. A new resource-constrained triage method applied to victims of penetrating injury. J Trauma. 2007;63(2):316-325. http://dx.doi.org/10.1097/TA.0b013e31806bf212.Google Scholar
17. Navin, D, Sacco, W, McGill, G. Application of a new resource-constrained triage method to military-age victims. Mil Med. 2009;174(12):1247-1255. http://dx.doi.org/10.7205/MILMED-D-04-1608.Google Scholar
18. Qazi, K, Kempf, JA, Christopher, NC, et al. Paramedic judgment of the need for trauma team activation for pediatric patients. Acad Emerg Med. 1998;5(10):1002-1007. http://dx.doi.org/10.1111/j.1553-2712.1998.tb02780.x.Google Scholar
19. Fries, G, McCalla, G, Levitt, M, et al. A prospective comparison of paramedic judgment and the trauma triage rule in the prehospital setting. Ann Emerg Med. 1994;24(5):885-889. http://dx.doi.org/10.1016/S0196-0644(94)70207-1.Google Scholar
20. Cicero, MX, Brown, L, Overly, F, et al. Creation and Delphi-method refinement of pediatric disaster triage simulations. Prehosp Emerg Care. 2014;18(2):282-289. http://dx.doi.org/10.3109/10903127.2013.856505.CrossRefGoogle ScholarPubMed
21. Kuisma, M, Hiltunen, T, Määttä, T, et al. Analysis of multiple casualty incidents - a prospective cohort study. Acta Anaesthesiol Scand. 2005;49(10):1527-1533. http://dx.doi.org/10.1111/j.1399-6576.2005.00761.x.Google Scholar
22. Schenk, E, Wijetunge, G, Mann, NC, et al. Epidemiology of mass casualty incidents in the United States. Prehosp Emerg Care. 2014;18(3):408-416. http://dx.doi.org/10.3109/10903127.2014.882999.CrossRefGoogle ScholarPubMed