Simple triage and rapid treatment protocol for emergency department mass casualty incident victim triage.
Am J Emerg Med
; 53: 99-103, 2022 Mar.
Article
em En
| MEDLINE
| ID: mdl-35007873
ABSTRACT
OBJECTIVE:
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.METHODS:
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.RESULTS:
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%).CONCLUSIONS:
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Planejamento em Desastres
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Incidentes com Feridos em Massa
Tipo de estudo:
Guideline
/
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article