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UK triage--an improved tool for an evolving threat.

Simon Horne1, James Vassallo, James Read

  • 1Ministry of Defence Hospital Unit Derriford, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, Devon PL6 8DH, United Kingdom. psihorne@doctors.org.uk

Injury
|November 15, 2011
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Summary

The military triage sieve (MS) is more sensitive than the UK Triage Sieve (TS) for identifying critically injured casualties in military trauma. While MS shows improved sensitivity, further adjustments to physiological parameters may enhance its effectiveness in major incident triage.

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Area of Science:

  • Emergency Medicine
  • Trauma Care
  • Triage Systems

Background:

  • Effective triage is crucial for survival during major incidents.
  • The UK Triage Sieve (TS) uses mobility, respiratory rate (RR), heart rate (HR), or capillary refill time.
  • The military version (MS) adds consciousness assessment (Glasgow Coma Score - GCS).

Purpose of the Study:

  • To evaluate if the MS better predicts the need for life-saving interventions in a military trauma population.
  • To determine optimal thresholds for HR, RR, and GCS in triage.

Main Methods:

  • A gold standard for Priority 1 casualties was established using resource-based criteria.
  • Pre-hospital data from a military trauma database were analyzed.
  • Sensitivity and specificity of triage categories were calculated and compared to the gold standard.

Main Results:

  • The MS demonstrated significantly higher sensitivity (59%) compared to the TS (53%) in identifying critical casualties (p<0.001).
  • Specificity was comparable between MS (89%) and TS (88%).
  • Optimizing physiological cut-offs improved sensitivity to 71% but reduced specificity.

Conclusions:

  • The MS is a more sensitive triage tool than the TS for military trauma.
  • Major incident planners should consider adopting the MS as a primary triage tool.
  • Further validation and potential adjustment of HR and RR thresholds could enhance MS performance.