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Prehospital Disaster Triage Does Not Predict Pediatric Outcomes: Comparing the Criteria Outcomes Tool to Three Mass-Casualty Incident Triage Algorithms

Published online by Cambridge University Press:  16 August 2021

Mark X. Cicero ,
Genevieve R. Santillanes ,
Keith P. Cross Open the ORCID record for Keith P. Cross [Opens in a new window] ,
Amy H. Kaji  and
J. Joelle Donofrio
Mark X. Cicero
Affiliation:
Yale School of Medicine, New Haven, ConnecticutUSA
Genevieve R. Santillanes
Affiliation:
Keck School of Medicine, University of Southern California, Los Angeles, CaliforniaUSA
Keith P. Cross*
Affiliation:
University at Buffalo Jacobs School of Medicine, Buffalo, New YorkUSA
Amy H. Kaji
Affiliation:
Harbor-UCLA Medical Center, Torrance, CaliforniaUSA
J. Joelle Donofrio
Affiliation:
Rady Children’s Hospital of San Diego and University of California at San Diego, San Diego, CaliforniaUSA
*
Correspondence: Keith P. Cross, MD 285 Middlesex Rd Buffalo, New York14216USA E-mail: kcross@upa.chob.edu
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Abstract

Introduction:

It remains unclear which mass-casualty incident (MCI) triage tool best predicts outcomes for child disaster victims.

Study Objectives:

The primary objective of this study was to compare triage outcomes of Simple Triage and Rapid Treatment (START), modified START, and CareFlight in pediatric patients to an outcomes-based gold standard using the Criteria Outcomes Tool (COT). The secondary outcomes were sensitivity, specificity, under-triage, over-triage, and overall accuracy at each level for each MCI triage algorithm.

Methods:

Singleton trauma patients under 16 years of age with complete prehospital, emergency department (ED), and in-patient data were identified in the 2007-2009 National Trauma Data Bank (NTDB). The COT outcomes and procedures were translated into ICD-9 procedure codes with added timing criteria. Gold standard triage levels were assigned using the COT based on outcomes, including mortality, injury type, admission to the hospital, and surgical procedures. Comparison triage levels were determined based on algorithmic depictions of the three MCI triage tools.

Results:

A total of 31,093 patients with complete data were identified from the NTDB. The COT was applied to these patients, and the breakdown of gold standard triage levels, based on their actual clinical outcomes, was: 17,333 (55.7%) GREEN; 11,587 (37.3%) YELLOW; 1,572 (5.1%) RED; and 601 (1.9%) BLACK. CareFlight had the best sensitivity for predicting COT outcomes for BLACK (83% [95% confidence interval, 80%-86%]) and GREEN patients (79% [95% CI, 79%-80%]) and the best specificity for RED patients (89% [95% CI, 89%-90%]).

Conclusion:

Among three prehospital MCI triage tools, CareFlight had the best performance for correlating with outcomes in the COT. Overall, none of three tools had good test characteristics for predicting pediatric patient needs for surgical procedures or hospital admission.

Keywords

childinjuriesmass-casualty incidentstriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 5 , October 2021 , pp. 503 - 510
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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