Diagnostic precision of triage algorithms for mass casualty incidents. English version.

BACKGROUND: Regarding survival and quality of life recent mass casualty incidents again emphasize the importance of early identification of the correct degree of injury/illness to enable prioritization of treatment amongst patients and their transportation to an appropriate hospital. The present study investigated existing triage algorithms in terms of sensitivity (SE) and specificity (SP) as well as its process duration in a relevant emergency patient cohort. METHODS: In this study 500 consecutive air rescue missions were evaluated by means of standardized patient records. Classification of patients was accomplished by 19 emergency physicians. Every case was independently classified by at least 3 physicians without considering any triage algorithm. Existing triage algorithms Primary Ranking for Initial Orientation in Emergency Medical Services (PRIOR), modified Simple Triage and Rapid Treatment (mSTaRT), Field Triage Score (FTS), Amberg-Schwandorf Algorithm for Triage (ASAV), Simple Triage and Rapid Treatment (STaRT), Care Flight, and Triage Sieve were additionally carried out computer based on each case, to enable calculation of quality criteria. RESULTS: The analyzed cohort had an age of (mean ± SD) 59 ± 25 years, a NACA score of 3.5 ± 1.1 and consisted of 57% men. On arrival 8 patients were deceased. Consequently, 492 patients were included in the analysis. The distribution of triage categories T1/T2/T3 were 10%/47%/43%, respectively. The highest diagnostic quality was achieved with START, mSTaRT, and ASAV yielding a SE of 78% and a SP ranging from 80-83%. The subgroup of surgical patients reached a SE of 95% and a SP between 85-91%. The newly established algorithm PRIOR exerted a SE of 90% but merely a SP of 54% in the overall cohort thereby consuming the longest time for overall decision. CONCLUSION: Triage procedures with acceptable diagnostic quality exist to identify the most severely injured. Due to its high rate of false positive results (over-triage) the recently developed PRIOR algorithm will cause overload of available resources for the severely injured within mass casualty incident missions. Non-surgical patients still are poorly identified by the available algorithms.

[Nationwide implementation of a hospital resource register for daily trauma care, mass casualties and disasters : Position paper of the German Trauma Society and the Federation of German Medical Directors of Emergency Medical Services]. / Bundesweite Einführung eines Krankenhauskatasters in den Klinikalltag und bei Großschadens- und Bedrohungslagen : Positionspapier der DGU und des BV-ÄLRD e. V.

The introduction of requirements for a minimum intake capacity of trauma patients by the German Trauma Society (DGU) into the so-called white book of treatment of seriously injured patients, is helpful for a sufficient preparation for threats and for dealing with mass casualties for trauma centers as well as for the emergency medical services (EMS). In the hospital information database provided by the Federation of German Medical Directors of Emergency Medical Services, more than 1300 hospitals are currently listed. This information supports the allocation of trauma patients from the field to the appropriate trauma center. Currently, without any coordination requirements, the current 626 trauma centers in Germany are able to immediately handle 6260 patients. This number could be doubled by activating the local hospital action plan, where a priority plan is set up. Additionally, the implementation of a nationwide flexible standardized communication structure between the dispatch center of the ambulance service and the hospitals, would improve daily care as well as the management of threats and mass casualties. It is the obligation of the local medical director of the EMS, to maintain and update the hospital database. Providing the information in the database with the hospital resources and the flexible standard communication structure, is appropriate to improve the daily collaboration and the preparation for mass casualties.

[Diagnostic quality of triage algorithms for mass casualty incidents]. / Diagnostische Güte von Vorsichtungsalgorithmen für den Massenanfall von Verletzten und Erkrankten.

BACKGROUND: Regarding survival and quality of life, recent mass casualty incidents have once more emphasized the importance of early identification of the correct degree of injury or illness, to enable prioritizing treatment of patients and transportation to an appropriate hospital. The present study investigated international triage algorithms in terms of sensitivity (SE) and specificity (SP) as well as the process duration in a relevant emergency patient cohort. METHODS: A total of 500 consecutive air rescue missions were evaluated by means of standardized patient records. Interdisciplinary classification of patients was accomplished by 19 emergency physicians. Every case was independently classified according to the triage category by at least three physicians without considering any triage algorithm. The available triage algorithms PRIOR (Primary Ranking for Initial Orientation in Emergency Medical Services), mSTaRT (modified Simple Triage and Rapid Treatment), FTS (Field Triage Score), ASAV (Amberg-Schwandorf Algorithm for Triage), STaRT (Simple Triage and Rapid Treatment), CareFlight triage and Triage Sieve were additionally carried out for each patient in a computer-based procedure, to enable calculation of test quality criteria for all procedures. RESULTS: The analyzed cohort had a mean age of 59 ± 25 years (±SD), a National Advisory Committee for Aeronautics (NACA) score of 3.5 ± 1.1 and consisted of 57% men. On arrival 8 patients were already deceased, consequently 492 patients were included in the analysis. The distributions of triage categories I/II/III were 10%/47%/43%, respectively. The highest diagnostic quality was achieved with START, mSTaRT, and ASAV with 78% SE and 80-83% SP. The subgroup of surgical patients achieved 95% SE and 85-91% SP. The newly established algorithm PRIOR exerted an SE of 90% but an SP of only 54% in the overall cohort thereby taking the longest overall time for decisions. CONCLUSION: Triage procedures with acceptable diagnostic quality exist to identify the most severely injured. Due to its high rate of false positive results (overtriage) in this study, the recently developed PRIOR algorithm could result in exhaustion of available resources for the severely injured and therefore to undertreatment of correctly assigned triage category I cases within mass casualty incidents. Non-surgical patients are still poorly allocated by the available algorithms. Contribution available free of charge by "Free Access".