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Prehospital Thrombolysis: A Manual from Berlin

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Published on: November 26, 2013

START triage: does it work?

Mark E Gebhart¹, Robert Pence

¹Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio 45420, USA. mark.gebhart@wright.edu

Disaster Management & Response : DMR : an Official Publication of the Emergency Nurses Association

|August 28, 2007

Summary

The Simple Triage and Rapid Treatment (START) protocol shows promise in predicting mortality risk for mass casualty incident trauma victims. Lower START scores correlated with higher mortality rates, indicating its potential efficacy in emergency triage.

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Area of Science:

Emergency Medicine
Trauma Surgery
Disaster Management

Background:

Mass casualty incidents (MCIs) necessitate rapid victim triage.
The Simple Triage and Rapid Treatment (START) protocol aims to differentiate between salvageable victims and those with imminent mortality.
This study assesses the START protocol's effectiveness in predicting mortality risk in MCI trauma patients.

Purpose of the Study:

To evaluate the efficacy of the START triage protocol.
To determine the correlation between START scores and mortality likelihood in trauma victims.
To validate START's predictive capability in mass casualty scenarios.

Main Methods:

Trauma patients were randomly selected from a Level II trauma center database.
Survival was defined as hospital discharge; the primary endpoint was death.
START scores were calculated based on respiratory rate, pulse, and Glasgow Coma Scale, then analyzed against mortality data.

Main Results:

Out of 355 patients, 96% survived and 3.9% died.
For scores ≤1, the positive predictive value (PPV) for mortality was 0.4, and the negative predictive value (NPV) was 0.98.
For scores ≥2, the PPV was 0.08, and the NPV was 0.99, with lower scores trending towards deceased victims.

Conclusions:

A significant majority (75.77%) of victims with specific vital signs survived.
Deceased victims showed a trend of lower START scores (50% mortality for score 1, 28% for score 2, 21% for score 3).
The observed trend suggests the START triage protocol is effective in predicting mortality risk during MCIs.