Does START triage work? An outcomes assessment after a disaster.

Area of Science:

• Emergency Medicine
• Disaster Triage
• Public Health

Background:

• The Simple Triage and Rapid Treatment (START) system is a widely used mass casualty triage tool in the US.
• No prior outcomes assessment has validated the accuracy of START triage levels against actual patient clinical status post-disaster.

Purpose of the Study:

• To evaluate the performance of the START system in a real-world disaster scenario.
• To determine if START triage levels accurately reflect patient acuity and clinical outcomes.
• To assess if START ensures timely transport of the most critical patients.

Main Methods:

• A train crash disaster in 2003 was used to evaluate START performance.
• Field triage categories and scene times were collected from county reports.
• Patient medical records were reviewed at receiving hospitals to determine outcomes-based triage categories.
• Comparison of field and outcomes-based triage categories assessed appropriateness.

Main Results:

• Analysis of 148 patient records revealed significant discrepancies between field triage and outcomes-based assessment.
• Seventy-nine patients were overtriaged, and 3 were undertriaged, with only 66 matching their assigned level.
• No triage level met the 90% sensitivity and specificity hypothesis, though red was 100% sensitive and green 89.3% specific.

Conclusions:

• The START system demonstrated poor agreement between assigned triage levels and actual patient outcomes in this disaster.
• START achieved acceptable undertriage for critical (red) and minor (green) patients but had substantial overtriage.
• Despite accuracy issues, START effectively prioritized the transport of the most critical patients to hospitals first.