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Comparison of Outcome Tools Used to Test Mass-Casualty Algorithms in the Pediatric Population

J Joelle Donofrio1,2, Alaa Shaban3, Amy H Kaji4

  • 1University of California San Diego Departments of Pediatrics and Emergency Medicine, San Diego, CaliforniaUSA.

Prehospital and Disaster Medicine
|October 6, 2021
PubMed

Insights

Comparing pediatric mass-casualty incident (MCI) triage tools reveals significant variability. The Criteria Outcomes Tool (COT) showed inconsistent agreement with other measures, highlighting the need for a standardized pediatric MCI assessment.

Area of Science:

  • Emergency Medicine
  • Pediatric Triage
  • Mass Casualty Incident (MCI) Management

Background:

  • Mass-casualty incident (MCI) algorithms are crucial for rapid patient categorization based on severity.
  • Current pediatric MCI triage lacks a consensus on standardized accuracy testing and inter-tool agreement.
  • Existing outcome measures show variability when applied to pediatric MCI scenarios.

Purpose of the Study:

  • To compare the agreement of the Criteria Outcomes Tool (COT) with established outcome measures.
  • To assess the performance of various tools in categorizing simulated pediatric MCI patients.
  • To evaluate inter-tool agreement for pediatric mass-casualty incident triage.

Main Methods:

  • A retrospective cohort of 247 pediatric trauma patients (<14 years) was analyzed.
  • Triage categories (black, red, yellow, green) were assigned using COT and other outcome measures (modified Baxt, mortality, LOS, ISS).
  • Descriptive statistics were used to quantify agreement between the Criteria Outcomes Tool and other measures.

Main Results:

  • Mortality showed 100% agreement with the COT black category.
  • The 'modified Baxt positive and alive' outcome had the highest agreement with COT red (65%).
  • Agreement for COT yellow ranged from 47%-53%, and 'modified Baxt negative and <24 hours LOS' showed 89% agreement with COT green.

Conclusions:

  • Assessing pediatric MCI triage algorithms is challenging due to the absence of a gold standard outcome tool.
  • Significant variability exists between different outcome measures used for pediatric MCI triage.
  • Further research is needed to establish standardized and reliable methods for evaluating pediatric MCI triage tools.
Abstract

Keywords:
mass-casualty incidentoutcomestriage

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