[The Berlin mass casualty hospital triage algorithm : Development, implementation and influence on exercise-based...

Area of Science:

• Emergency Medicine
• Disaster Management
• Clinical Triage Systems

Background:

• Patient triage is critical for effective mass disaster management and resource allocation.
• Previous hospital disaster training in Berlin revealed significant triage classification issues, including overtriaging and undertriaging.
• A tailored triage algorithm was developed and implemented in Berlin hospitals in 2015.

Purpose of the Study:

• To validate the effectiveness of the newly implemented Berlin hospital triage algorithm.
• To investigate the impact of the algorithm on patient classification accuracy and resource allocation during disaster scenarios.

Main Methods:

• A prospective observational study compared unheralded hospital disaster training exercises from 2016-2017 (with the algorithm) to 2010-2011 (without the algorithm).
• Evaluated 556 participants in post-implementation drills and 601 in pre-implementation drills.
• Assessed correct allocation to triage categories (T1-T3), specificity, sensitivity, and likelihood ratios.

Main Results:

• The new triage algorithm achieved significantly improved overall triage accuracy, rising from 63% to 80%.
• Correct classification rates for T1, T2, and T3 categories were 85%, 63%, and 87%, respectively.
• The algorithm demonstrated high specificity (97% for T1) and sensitivity (88% for T3), with significant reductions in overtriaging and undertriaging.

Conclusions:

• The Berlin hospital triage algorithm was successfully validated, demonstrating significant improvements in patient triage accuracy.
• Implementation of the algorithm led to enhanced triage category allocation and a marked decrease in misclassified patients.
• The validated algorithm is a valuable tool for optimizing patient management in mass disaster scenarios.