Comparative analysis of multiple-casualty incident triage algorithms.

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Public Health

Background:

• Accurate patient triage is critical during mass casualty incidents (MCIs).
• Existing triage algorithms and their physiological variables require validation for predicting critical injury.

Purpose of the Study:

• To retrospectively assess the accuracy of MCI triage algorithms and their physiological components in identifying critically injured adult patients.
• To compare the predictive performance of Triage Sieve, Simple Triage and Rapid Treatment (START), modified START, and CareFlight Triage.

Main Methods:

• Retrospective review of 1,144 adult patients admitted to trauma centers.
• Analysis of associations between out-of-hospital physiological variables and a resource-based definition of severe injury.
• Evaluation of triage algorithms including Triage Sieve, START, modified START, and CareFlight Triage.

Main Results:

• The Motor Component of the Glasgow Coma Scale and systolic blood pressure demonstrated the strongest association with severe injury.
• CareFlight Triage, START, and modified START showed comparable sensitivities (82-85%) for predicting critical injury.
• CareFlight Triage exhibited higher specificity (96%) compared to START (86%) and modified START (91%).
• Triage Sieve algorithms were significantly less effective predictors of severe injury.

Conclusions:

• Motor Glasgow Coma Scale and systolic blood pressure are key physiological predictors of severe injury.
• CareFlight Triage demonstrated superior specificity in identifying critical trauma patients compared to START and modified START.
• Findings require prospective validation, as patient populations in actual MCIs may differ from those in this study.