A multi-national observational study on the concordance between the translational triage tool and routine prehospital...

Effective and standardized prehospital triage is crucial in mass casualty incidents (MCIs) to optimize patient outcomes. Existing triage systems often vary by region, creating challenges for multinational disaster response. A "translational" tool, intended to support interoperability and potentially bridge routine and MCI contexts, has been proposed. As a preliminary step, this study evaluates the concordance, defined here as the post-hoc categorical agreement) of the translational triage tool (TTT) with established, routine triage systems across diverse international settings. This multinational observational study included 301 patients from Poland, Saudi Arabia, and Thailand. Agreement between the routine triage outcome and TTT categorization applied by the observer was assessed within each country using Cohen's kappa (linear and quadratic weights). For sites using five-level routine systems (CTAS / ESI), categories were pre-specified and collapsed into a three-level framework for comparison (CTAS 1 = Red; CTAS 2 = Yellow; CTAS 3-5 = Green; ESI 1 = Red; ESI 2 = Yellow; ESI 3-5 = Green). Cross-tabulations were used to describe patterns of discordance (over- and under-triage relative to the local routine triage system). No inferential comparisons between the tools were performed beyond agreement estimates because the data were categorical/ordinal and pooled analyses were not defensible given heterogeneity across sites. Agreement levels varied across countries: complete categorical concordance in Poland (kappa = 1.000), substantial in Saudi Arabia (kappa = 0.810), and good in Thailand (kappa = 0.701). Discordant cases in Saudi Arabia and Thailand suggested that the physiologically focused TTT-more often assigned lower urgency to patients with stable physiology but high-risk presentations or medical histories, while sometimes assigning higher urgency when respiratory signs appeared abnormal. The TTT shows strong alignment with the physiologically oriented START approach but diverges from complaint- and risk-modifier-driven systems such as CTAS and ESI, particularly when assigning of lower urgency to some high-risk presentations without overt physiological compromise. This study assesses post-hoc concordance rather than clinical accuracy or patient outcomes; therefore, the findings should not be interpreted as validation of TTT for routine clinical use. The pattern of agreement with START and discordance with CTAS/ESI systems is consistent with a physiologically driven disaster triage approach, and future studies should evaluate the TTT specifically in surge / MCI contexts, including operational feasibility and outcome-based safety.