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Comparison of prehospital professional accuracy, speed, and interrater reliability of six pediatric triage algorithms

Tabitha Cheng1, Katherine Staats1, Amy H Kaji2

  • 1Department of Emergency Medicine UCSD San Diego USA.

Journal of the American College of Emergency Physicians Open
|January 21, 2022
PubMed

Insights

Pediatric mass casualty incident (MCI) triage algorithms show a trade-off between accuracy and speed. The Sacco Triage Method (STM) was most accurate and reliable, but slowest, while others were faster but less accurate.

Area of Science:

  • Emergency Medicine
  • Disaster Triage
  • Pediatric Triage

Background:

  • Effective triage is critical during pediatric mass casualty incidents (MCIs).
  • Prehospital professionals' performance with various triage tools is not fully understood.

Purpose of the Study:

  • To evaluate the accuracy, speed, and interrater reliability of five pediatric disaster triage algorithms.
  • To compare these algorithms against a no-tool approach in a simulated pediatric MCI.

Main Methods:

  • 107 prehospital professionals participated in a tabletop exercise with 25 pediatric victims.
  • Triage algorithms evaluated included CareFlight (CF), Simple Triage and Rapid Treatment (START) and JumpSTART (J-START), Pediatric Triage Tape (PTT), Sort, Assess, Life-saving interventions, Treatment/Transport (SALT), and Sacco Triage Method (STM).
  • Performance metrics included accuracy, speed, and interrater reliability against a criterion standard.

Main Results:

  • Sacco Triage Method (STM) showed the highest accuracy (89.3%) and interrater reliability.
  • Pediatric Triage Tape (PTT) had the lowest accuracy (67.8%) and highest overtriage.
  • CareFlight (CF), SALT, and No Algorithm (NA) were the fastest, completing triage in 5 minutes or less.

Conclusions:

  • No single pediatric triage algorithm excelled in all evaluated measures (accuracy, speed, reliability).
  • A common challenge in MCI triage is the inverse relationship between accuracy/reliability and speed.
  • Further research in larger drills or real-world events is necessary to validate these findings.
Abstract

Keywords:
CareFlightJumpSTARTSALTchildrendisasteremergency medical servicesmass casualty triagepediatric triage tapeprehospitalsacco triage method

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