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A Scoping Review of Pediatric Mass-Casualty Incident Triage Algorithms

Chady El Tawil1, Amy Bergeron2, Elene Khalil1

  • 1Division of Pediatric Emergency Medicine, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada.

Disaster Medicine and Public Health Preparedness
|February 15, 2023
PubMed

Insights

No pediatric mass-casualty incident (MCI) triage system is consistently accurate. A new secondary triage system shows promise, but further research is needed for reliable pediatric MCI patient care.

Area of Science:

  • Emergency Medicine
  • Pediatric Critical Care
  • Disaster Management

Background:

  • Pediatric mass-casualty incident (MCI) triage lacks a universally accepted system.
  • Current systems may exhibit poor reliability and agreement among providers.
  • Existing methods risk underestimating or missing critically ill pediatric patients.

Purpose of the Study:

  • To conduct a scoping review to identify the most accurate triage system for pediatric patients in mass-casualty incidents (MCIs).

Main Methods:

  • Searched multiple databases including MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Scopus, Global Health, Global Health Archive, and Global Index Medicus.
  • Included studies focused on the accuracy of single systems, comparisons of primary triage systems, and comparisons of secondary triage systems.
  • Grey literature was also searched to ensure comprehensive data collection.

Main Results:

  • Out of 996 identified studies, 18 were included in the review.
  • Triage systems demonstrated poor inter-rater reliability, low provider agreement, and inadequate external validation.
  • While no single primary pediatric MCI triage algorithm was found to be definitively most accurate, one newly developed secondary triage system outperformed its comparison.
  • 11 studies compared different pediatric MCI triage algorithms, but a superior primary algorithm was not identified.

Conclusions:

  • No primary triage algorithm currently meets the accuracy requirements for the pediatric population in mass-casualty incidents.
  • A specific secondary triage algorithm demonstrated superiority, suggesting potential for improved pediatric patient management in MCIs.
  • Further research and validation are necessary to establish reliable triage protocols for pediatric mass-casualty events.
Abstract

Keywords:
mass casualty incidentspediatric emergency medicinetriage

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