Abstract
Objective
Two common mass casualty triage algorithms are Simple Triage Algorithm and Rapid Treatment
(START) and Sort, Assess, Lifesaving, Interventions, Treatment, and Transportation
(SALT). We sought to determine the START and SALT efficacy in predicting clinical
outcome by appropriate triage.
Methods
We performed a retrospective chart review of trauma registry of patients from our
emergency department (ED). We applied the triage algorithms to 100 patient charts.
The end points categories were defined by patient outcomes and the need for intervention:
minor/green, discharged without intervention other than minor ED procedure; delayed/yellow,
patients get an intervention more than 12 hours after arrival to the ED; immediate/red,
patients get an intervention less than 12 hours after arrival; dead/expectant/black,
patients die within 48 hours after arrival.
Results
The mean age was 47 years (range, 17-92 years), and 72% were male. The mechanism of
injury was 41% motor vehicle collision, 32% fall, and 16% penetrating trauma. Hospital
outcome was 60% minor/green, 5% delayed/yellow, 29% immediate/red, and 6% dead/black.
The SALT method resulted in 5 patients overtriaged (95% confidence interval [CI],
1.6-11.2), 30 undertriaged (95% CI, 21.2-40), and 65 met triage level (95% CI, 54.8-74.3).
The START method resulted in 12 overtriage (95% CI, 6.4-20), 33 undertriaged (95%
CI, 23.9-43.1), and 55 at triage level (95% CI, 44.7-65). Within triage levels, sensitivity
ranged from 0% to 92%, specificity from 55% to 100%, positive predictive values from
10% to 100%, and negative predictive value from 65% to 97%.
Conclusion
Overall, neither SALT nor START was sensitive or specific for predicting clinical
outcome.
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References
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Article Info
Publication History
Published online: August 13, 2015
Accepted:
August 11,
2015
Received in revised form:
July 28,
2015
Received:
June 16,
2015
Footnotes
☆No outside funding was provided.
☆☆Presented as a poster at the Society of Academic Emergency Medicine annual meeting, May 2015.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
