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Comparing the Accuracy of Three Pediatric Disaster Triage Strategies: A Simulation-Based Investigation
Mark X Cicero1, Frank Overly2, Linda Brown2
11Department of Emergency Medicine,Yale School of Medicine,New Haven,Connecticut.
Insights
JumpSTART pediatric disaster triage demonstrated superior accuracy compared to Smart triage and clinical decision-making. This strategy improved outcomes for RED, YELLOW, and BLACK patient categories in disaster simulations.
Area of Science:
- Emergency Medicine
- Disaster Preparedness
- Pediatric Triage
Background:
- Pediatric disaster triage (PDT) strategies lack clear evidence regarding optimal accuracy and patient outcomes.
- The effectiveness of different PDT approaches remains an area of active research and clinical inquiry.
Purpose of the Study:
- To compare the accuracy and patient outcomes of two pediatric disaster triage strategies: JumpSTART and Smart.
- To evaluate clinical decision-making (CDM) without an algorithm against standardized PDT strategies.
Main Methods:
- A cross-sectional analysis of emergency medical services providers using simulated disaster scenarios.
- Comparison of triage accuracy across JumpSTART, Smart, and CDM groups using a Delphi method for expected triage levels.
- Analysis of triage performance for RED, YELLOW, GREEN, and BLACK patient categories.
Main Results:
- JumpSTART triage showed significantly greater accuracy than Smart triage (P<0.001) and CDM (P=0.02).
- JumpSTART demonstrated superior performance for RED (P=0.05 vs. Smart) and YELLOW patients (P<0.001 vs. Smart and CDM).
- JumpSTART also outperformed CDM in the triage of BLACK patients (P=0.01).
Conclusions:
- Simulation results suggest JumpSTART is a more accurate pediatric disaster triage strategy than Smart or CDM.
- JumpSTART provides improved triage accuracy for critically ill (RED), delayed (YELLOW), and deceased (BLACK) patients in simulated mass casualty incidents.
- The findings support the adoption of JumpSTART for enhancing pediatric disaster response effectiveness.
Background:
It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes.
Methods:
We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients' expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased).
Results:
There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (P<0.001; OR [odds ratio]: 2.03; interquartile range [IQR]: 1.30, 3.17) or CDM (P=0.02; OR: 1.76; IQR: 1.10, 2.82). JumpSTART outperformed Smart for RED patients (P=0.05; OR: 1.48; IQR: 1.01,2.17), and outperformed both Smart (P<0.001; OR: 3.22; IQR: 1.78,5.88) and CDM (P<0.001; OR: 2.86; IQR: 1.53,5.26) for YELLOW patients. Furthermore, JumpSTART outperformed CDM for BLACK patients (P=0.01; OR: 5.55; IQR: 1.47, 20.0).
Conclusion:
Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM.
