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Inter-Rater Reliability and Agreement Among Mass-Casualty Incident Algorithms Using a Pediatric Trauma Dataset: A Pilot Study

Published online by Cambridge University Press:  20 April 2022

Emilia H. Fisher Open the ORCID record for Emilia H. Fisher [Opens in a new window] ,
Ilene Claudius Open the ORCID record for Ilene Claudius [Opens in a new window] ,
Amy H. Kaji ,
Alaa Shaban ,
Nicholas McGlynn ,
Mark X. Cicero ,
Genevieve Santillanes ,
Marianne Gausche-Hill ,
Todd P. Chang Open the ORCID record for Todd P. Chang [Opens in a new window]  and
J. Joelle Donofrio-Odmann
Emilia H. Fisher*
Affiliation:
Department of Emergency Medicine, Children’s Minnesota, Minneapolis, MinnesotaUSA
Ilene Claudius
Affiliation:
Harbor-UCLA Medical Center, Emergency Medicine, Torrance, CaliforniaUSA David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaUSA The Lundquist Institute at Harbor-UCLA, Los Angeles, CaliforniaUSA
Amy H. Kaji
Affiliation:
Harbor-UCLA Medical Center, Emergency Medicine, Torrance, CaliforniaUSA David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaUSA The Lundquist Institute at Harbor-UCLA, Los Angeles, CaliforniaUSA
Alaa Shaban
Affiliation:
Community Health Centers, Pediatrics, Santa Maria, CaliforniaUSA
Nicholas McGlynn
Affiliation:
Keck School of Medicine of University of Southern California, Los Angeles, CaliforniaUSA
Mark X. Cicero
Affiliation:
Yale University School of Medicine, New Haven, ConnecticutUSA
Genevieve Santillanes
Affiliation:
Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CaliforniaUSA
Marianne Gausche-Hill
Affiliation:
Harbor-UCLA Medical Center, Emergency Medicine, Torrance, CaliforniaUSA David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaUSA The Lundquist Institute at Harbor-UCLA, Los Angeles, CaliforniaUSA Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CaliforniaUSA
Todd P. Chang
Affiliation:
Children’s Hospital Los Angeles, Los Angeles, CaliforniaUSA
J. Joelle Donofrio-Odmann
Affiliation:
University of California San Diego Departments of Pediatrics and Emergency Medicine, San Diego, CaliforniaUSA Rady Children’s Hospital of San Diego, San Diego, CaliforniaUSA
*
Correspondence: Emilia H. Fisher Children’s Minnesota - Department of Emergency Medicine 2525 Chicago Ave South Mailstop 32-1488 Minneapolis, Minnesota55404USA E-mail: [email protected]
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Abstract

Introduction:

Many triage algorithms exist for use in mass-casualty incidents (MCIs) involving pediatric patients. Most of these algorithms have not been validated for reliability across users.

Study Objective:

Investigators sought to compare inter-rater reliability (IRR) and agreement among five MCI algorithms used in the pediatric population.

Methods:

A dataset of 253 pediatric (<14 years of age) trauma activations from a Level I trauma center was used to obtain prehospital information and demographics. Three raters were trained on five MCI triage algorithms: Simple Triage and Rapid Treatment (START) and JumpSTART, as appropriate for age (combined as J-START); Sort Assess Life-Saving Intervention Treatment (SALT); Pediatric Triage Tape (PTT); CareFlight (CF); and Sacco Triage Method (STM). Patient outcomes were collected but not available to raters. Each rater triaged the full set of patients into Green, Yellow, Red, or Black categories with each of the five MCI algorithms. The IRR was reported as weighted kappa scores with 95% confidence intervals (CI). Descriptive statistics were used to describe inter-rater and inter-MCI algorithm agreement.

Results:

Of the 253 patients, 247 had complete triage assignments among the five algorithms and were included in the study. The IRR was excellent for a majority of the algorithms; however, J-START and CF had the highest reliability with a kappa 0.94 or higher (0.9-1.0, 95% CI for overall weighted kappa). The greatest variability was in SALT among Green and Yellow patients. Overall, J-START and CF had the highest inter-rater and inter-MCI algorithm agreements.

Conclusion:

The IRR was excellent for a majority of the algorithms. The SALT algorithm, which contains subjective components, had the lowest IRR when applied to this dataset of pediatric trauma patients. Both J-START and CF demonstrated the best overall reliability and agreement.

Keywords

disasterinter-rater reliabilitymass casualtypediatrictriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 3 , June 2022 , pp. 306 - 313
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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