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Simple triage and rapid treatment protocol for emergency department mass casualty incident victim triage
Triage plays an essential role in emergency medical care. It is crucial to adopt appropriate triage in a mass casualty incident (MCI) when resources are limited. The simple triage and rapid treatment (START) protocol is commonly used worldwide; however, the effectiveness of the START protocol for em...
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| Published in: | The American journal of emergency medicine 2022-03, Vol.53, p.99-103 |
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| description | Triage plays an essential role in emergency medical care. It is crucial to adopt appropriate triage in a mass casualty incident (MCI) when resources are limited. The simple triage and rapid treatment (START) protocol is commonly used worldwide; however, the effectiveness of the START protocol for emergency department (ED) triage is unclear. This study aimed to examine the accuracy of START for the ED triage of victims following a MCI.
We retrospectively reviewed the records of victims who presented to our ED during a MCI response after a train crash. The ED nurses applied the START protocol upon patient arrival, and we used a consensus-based standard to determine the outcome-based categories of these same patients. We compared the START protocol and outcome-based categories. In addition, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START in terms of predicting surgery and ED disposition were determined.
This study enrolled 47 patients (predominantly women, 68.1%; median age: 39.0years). Most victims were triaged into the START minor category (61.7%) and discharged from the ED (68.1%). Twenty-nine patients had matched START and outcome-based categories, whereas 2 patients were over-triaged and 16 patients were under-triaged. Additionally, the START system had acceptable AUC and sensitivities for predicting surgery and ED disposition (AUC/sensitivity/specificity for surgery: 0.850/100%/69.1%; AUC/sensitivity/specificity for admission: 0.917/93.3%/87.5%; AUC/sensitivity/specificity for intensive care unit (ICU)/ED death: 0.994/100%/97.8%).
This study demonstrated poor agreement between START categories, as determined in the ED, and the consensus-based standard categories. However, the START protocol was acceptable in terms of identifying emergent patients (100% sensitivity for the immediate and deceased categories) and predicting ED disposition (surgery, admission, and ICU/ED mortality). Although START is not perfect, our findings suggest that it could be used for the ED triage of trauma-related MCI victims.
•Research on in-hospital mass casualty triage is insufficient and inconsistent.•The accuracy of the START protocol was examined using a consensus-based standard.•Poor agreement was found between START and the consensus-based standard categories.•The START protocol had acceptable performance in identifying emergent patients.•The START protocol could be used for emergency department mass casualty triage. |
| doi_str_mv | 10.1016/j.ajem.2021.12.037 |
| format | article |
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We retrospectively reviewed the records of victims who presented to our ED during a MCI response after a train crash. The ED nurses applied the START protocol upon patient arrival, and we used a consensus-based standard to determine the outcome-based categories of these same patients. We compared the START protocol and outcome-based categories. In addition, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START in terms of predicting surgery and ED disposition were determined.
This study enrolled 47 patients (predominantly women, 68.1%; median age: 39.0years). Most victims were triaged into the START minor category (61.7%) and discharged from the ED (68.1%). Twenty-nine patients had matched START and outcome-based categories, whereas 2 patients were over-triaged and 16 patients were under-triaged. Additionally, the START system had acceptable AUC and sensitivities for predicting surgery and ED disposition (AUC/sensitivity/specificity for surgery: 0.850/100%/69.1%; AUC/sensitivity/specificity for admission: 0.917/93.3%/87.5%; AUC/sensitivity/specificity for intensive care unit (ICU)/ED death: 0.994/100%/97.8%).
This study demonstrated poor agreement between START categories, as determined in the ED, and the consensus-based standard categories. However, the START protocol was acceptable in terms of identifying emergent patients (100% sensitivity for the immediate and deceased categories) and predicting ED disposition (surgery, admission, and ICU/ED mortality). Although START is not perfect, our findings suggest that it could be used for the ED triage of trauma-related MCI victims.
•Research on in-hospital mass casualty triage is insufficient and inconsistent.•The accuracy of the START protocol was examined using a consensus-based standard.•Poor agreement was found between START and the consensus-based standard categories.•The START protocol had acceptable performance in identifying emergent patients.•The START protocol could be used for emergency department mass casualty triage.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2021.12.037</identifier><identifier>PMID: 35007873</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Accuracy ; Adult ; Clinical outcomes ; Clinical Protocols ; Disaster Planning - methods ; Earthquakes ; Emergency department triage ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital ; Female ; Humans ; Laboratories ; Mass casualty incident ; Mass Casualty Incidents ; Mortality ; Patients ; Performance evaluation ; Retrospective Studies ; Simple triage and rapid treatment ; Surgery ; Trauma ; Triage ; Triage - methods</subject><ispartof>The American journal of emergency medicine, 2022-03, Vol.53, p.99-103</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><rights>2021. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-8234279a9edba7691070083e11b954711fc6da3057eed8c5e81041f0a39522d53</citedby><cites>FETCH-LOGICAL-c384t-8234279a9edba7691070083e11b954711fc6da3057eed8c5e81041f0a39522d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35007873$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lin, Yun-Kuan</creatorcontrib><creatorcontrib>Chen, Kun-Chuan</creatorcontrib><creatorcontrib>Wang, Jen-Hung</creatorcontrib><creatorcontrib>Lai, Pei-Fang</creatorcontrib><title>Simple triage and rapid treatment protocol for emergency department mass casualty incident victim triage</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Triage plays an essential role in emergency medical care. It is crucial to adopt appropriate triage in a mass casualty incident (MCI) when resources are limited. The simple triage and rapid treatment (START) protocol is commonly used worldwide; however, the effectiveness of the START protocol for emergency department (ED) triage is unclear. This study aimed to examine the accuracy of START for the ED triage of victims following a MCI.
We retrospectively reviewed the records of victims who presented to our ED during a MCI response after a train crash. The ED nurses applied the START protocol upon patient arrival, and we used a consensus-based standard to determine the outcome-based categories of these same patients. We compared the START protocol and outcome-based categories. In addition, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START in terms of predicting surgery and ED disposition were determined.
This study enrolled 47 patients (predominantly women, 68.1%; median age: 39.0years). Most victims were triaged into the START minor category (61.7%) and discharged from the ED (68.1%). Twenty-nine patients had matched START and outcome-based categories, whereas 2 patients were over-triaged and 16 patients were under-triaged. Additionally, the START system had acceptable AUC and sensitivities for predicting surgery and ED disposition (AUC/sensitivity/specificity for surgery: 0.850/100%/69.1%; AUC/sensitivity/specificity for admission: 0.917/93.3%/87.5%; AUC/sensitivity/specificity for intensive care unit (ICU)/ED death: 0.994/100%/97.8%).
This study demonstrated poor agreement between START categories, as determined in the ED, and the consensus-based standard categories. However, the START protocol was acceptable in terms of identifying emergent patients (100% sensitivity for the immediate and deceased categories) and predicting ED disposition (surgery, admission, and ICU/ED mortality). Although START is not perfect, our findings suggest that it could be used for the ED triage of trauma-related MCI victims.
•Research on in-hospital mass casualty triage is insufficient and inconsistent.•The accuracy of the START protocol was examined using a consensus-based standard.•Poor agreement was found between START and the consensus-based standard categories.•The START protocol had acceptable performance in identifying emergent patients.•The START protocol could be used for emergency department mass casualty triage.</description><subject>Accuracy</subject><subject>Adult</subject><subject>Clinical outcomes</subject><subject>Clinical Protocols</subject><subject>Disaster Planning - methods</subject><subject>Earthquakes</subject><subject>Emergency department triage</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Mass casualty incident</subject><subject>Mass Casualty Incidents</subject><subject>Mortality</subject><subject>Patients</subject><subject>Performance evaluation</subject><subject>Retrospective Studies</subject><subject>Simple triage and rapid treatment</subject><subject>Surgery</subject><subject>Trauma</subject><subject>Triage</subject><subject>Triage - methods</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kUGL1TAUhYMozpvRP-BCAm7ctOYmTdOCGxmcURhw4cw65CW3Y0rT1iQdeP_ePN4bFy5cXTh853A5h5B3wGpg0H4aazNiqDnjUAOvmVAvyA6k4FUHCl6SHVNCVq2S6oJcpjQyBtDI5jW5EJIx1SmxI79--rBOSHP05hGpmR2NZvWuCGhywDnTNS55sctEhyVSDBgfcbYH6nA18UQEkxK1Jm1mygfqZ-vdUX7yNvtwjn5DXg1mSvj2fK_Iw83X--tv1d2P2-_XX-4qK7omVx0XDVe96dHtjWp7YIqxTiDAvpeNAhhs64xgUiG6zkrsgDUwMCN6ybmT4op8POWWt39vmLIOPlmcJjPjsiXNW-h61vOuL-iHf9Bx2eJcvisUV6UqKVWh-ImycUkp4qDX6IOJBw1MH3fQoz7uoI87aOC67FBM78_R2z6g-2t5Lr4An08Ali6ePEadrC-9ovMRbdZu8f_L_wOIBZkn</recordid><startdate>202203</startdate><enddate>202203</enddate><creator>Lin, Yun-Kuan</creator><creator>Chen, Kun-Chuan</creator><creator>Wang, Jen-Hung</creator><creator>Lai, Pei-Fang</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202203</creationdate><title>Simple triage and rapid treatment protocol for emergency department mass casualty incident victim triage</title><author>Lin, Yun-Kuan ; 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It is crucial to adopt appropriate triage in a mass casualty incident (MCI) when resources are limited. The simple triage and rapid treatment (START) protocol is commonly used worldwide; however, the effectiveness of the START protocol for emergency department (ED) triage is unclear. This study aimed to examine the accuracy of START for the ED triage of victims following a MCI.
We retrospectively reviewed the records of victims who presented to our ED during a MCI response after a train crash. The ED nurses applied the START protocol upon patient arrival, and we used a consensus-based standard to determine the outcome-based categories of these same patients. We compared the START protocol and outcome-based categories. In addition, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START in terms of predicting surgery and ED disposition were determined.
This study enrolled 47 patients (predominantly women, 68.1%; median age: 39.0years). Most victims were triaged into the START minor category (61.7%) and discharged from the ED (68.1%). Twenty-nine patients had matched START and outcome-based categories, whereas 2 patients were over-triaged and 16 patients were under-triaged. Additionally, the START system had acceptable AUC and sensitivities for predicting surgery and ED disposition (AUC/sensitivity/specificity for surgery: 0.850/100%/69.1%; AUC/sensitivity/specificity for admission: 0.917/93.3%/87.5%; AUC/sensitivity/specificity for intensive care unit (ICU)/ED death: 0.994/100%/97.8%).
This study demonstrated poor agreement between START categories, as determined in the ED, and the consensus-based standard categories. However, the START protocol was acceptable in terms of identifying emergent patients (100% sensitivity for the immediate and deceased categories) and predicting ED disposition (surgery, admission, and ICU/ED mortality). Although START is not perfect, our findings suggest that it could be used for the ED triage of trauma-related MCI victims.
•Research on in-hospital mass casualty triage is insufficient and inconsistent.•The accuracy of the START protocol was examined using a consensus-based standard.•Poor agreement was found between START and the consensus-based standard categories.•The START protocol had acceptable performance in identifying emergent patients.•The START protocol could be used for emergency department mass casualty triage.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35007873</pmid><doi>10.1016/j.ajem.2021.12.037</doi><tpages>5</tpages></addata></record> |
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| source | ScienceDirect Journals |
| subjects | Accuracy Adult Clinical outcomes Clinical Protocols Disaster Planning - methods Earthquakes Emergency department triage Emergency medical care Emergency medical services Emergency Service, Hospital Female Humans Laboratories Mass casualty incident Mass Casualty Incidents Mortality Patients Performance evaluation Retrospective Studies Simple triage and rapid treatment Surgery Trauma Triage Triage - methods |
| title | Simple triage and rapid treatment protocol for emergency department mass casualty incident victim triage |
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