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Performance characteristics of five triage tools for major incidents involving traumatic injuries to children
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Price, Charlotte L, Brace-McDonnell, Samantha J., Stallard, Nigel, Bleetman, Anthony, Maconochie, I. and Perkins, Gavin D. (2016) Performance characteristics of five triage tools for major incidents involving traumatic injuries to children. Injury, 47 (5). pp. 988-992. doi:10.1016/j.injury.2015.10.076
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Official URL: http://dx.doi.org/10.1016/j.injury.2015.10.076
Abstract
Context Triage tools are an essential component of the emergency response to a major incident. Although fortunately rare, mass casualty incidents involving children are possible which mandate reliable triage tools to determine the priority of treatment.
Objective
To determine the performance characteristics of five major incident triage tools amongst paediatric casualties who have sustained traumatic injuries.
Design, setting, participants
Retrospective observational cohort study using data from 31,292 patients aged less than 16 years who sustained a traumatic injury. Data were obtained from the UK Trauma Audit and Research Network (TARN) database.
Interventions Statistical evaluation of five triage tools (JumpSTART, START, CareFlight, Paediatric Triage Tape/Sieve and Triage Sort) to predict death or severe traumatic injury (injury severity score >15).
Main outcome measures Performance characteristics of triage tools (sensitivity, specificity and level of agreement between triage tools) to identify patients at high risk of death or severe injury.
Results
Of the 31,292 cases, 1029 died (3.3%), 6842 (21.9%) had major trauma (defined by an injury severity score >15) and 14,711 (47%) were aged 8 years or younger. There was variation in the performance accuracy of the tools to predict major trauma or death (sensitivities ranging between 36.4 and 96.2%; specificities 66.0–89.8%). Performance characteristics varied with the age of the child. CareFlight had the best overall performance at predicting death, with the following sensitivity and specificity (95% CI) respectively: 95.3% (93.8–96.8) and 80.4% (80.0–80.9). JumpSTART was superior for the triaging of children under 8 years; sensitivity and specificity (95% CI) respectively: 86.3% (83.1–89.5) and 84.8% (84.2–85.5). The triage tools were generally better at identifying patients who would die than those with non-fatal severe injury.
Conclusion
This statistical evaluation has demonstrated variability in the accuracy of triage tools at predicting outcomes for children who sustain traumatic injuries. No single tool performed consistently well across all evaluated scenarios.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RJ Pediatrics |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Social Sciences > Warwick Business School > Operational Research & Management Sciences Faculty of Social Sciences > Warwick Business School Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Triage (Medicine), Children -- Wounds and injuries, Traumatology, Pediatric intensive care, Pediatric emergencies -- Examinations, questions, etc. | ||||||||
| Journal or Publication Title: | Injury | ||||||||
| Publisher: | Elsevier | ||||||||
| ISSN: | 0020-1383 | ||||||||
| Official Date: | May 2016 | ||||||||
| Dates: |
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| Volume: | 47 | ||||||||
| Number: | 5 | ||||||||
| Page Range: | pp. 988-992 | ||||||||
| DOI: | 10.1016/j.injury.2015.10.076 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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