Many triage algorithms exist for use in mass-casualty incidents (MCIs) involving pediatric patients. Most of these algorithms have not been validated for reliability across users.

Investigators sought to compare inter-rater reliability (IRR) and agreement among five MCI algorithms used in the pediatric population.

A dataset of 253 pediatric (<14 years of age) trauma activations from a Level I trauma center was used to obtain prehospital information and demographics. Three raters were trained on five MCI triage algorithms: Simple Triage and Rapid Treatment (START) and JumpSTART, as appropriate for age (combined as J-START); Sort Assess Life-Saving Intervention Treatment (SALT); Pediatric Triage Tape (PTT); CareFlight (CF); and Sacco Triage Method (STM). Patient outcomes were collected but not available to raters. Each rater triaged the full set of patients into Green, Yellow, Red, or Black categories with each of the five MCI algorithms. The IRR was reported as weighted kappa scores with 95% confidence intervals (CI). Descriptive statistics were used to describe inter-rater and inter-MCI algorithm agreement.

Of the 253 patients, 247 had complete triage assignments among the five algorithms and were included in the study. The IRR was excellent for a majority of the algorithms; however, J-START and CF had the highest reliability with a kappa 0.94 or higher (0.9-1.0, 95% CI for overall weighted kappa). The greatest variability was in SALT among Green and Yellow patients. Overall, J-START and CF had the highest inter-rater and inter-MCI algorithm agreements.

The IRR was excellent for a majority of the algorithms. The SALT algorithm, which contains subjective components, had the lowest IRR when applied to this dataset of pediatric trauma patients. Both J-START and CF demonstrated the best overall reliability and agreement.

Considering the pediatric peculiarities and the difficulty of assisting this population in mass-casualty situations, this study aims to identify the main topics regarding children’s health care in mass-casualty incidents (MCIs) that are discussed in the Emergency Medicine area.

This systematic review was performed according to the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered with the PROSPERO database of systematic reviews with the number CRD42021229552. The last update of the search in the databases was on May 27, 2021 and resulted in 45 documents to be analyzed. The inclusion criteria included the peer-reviewed academic papers in English, Portuguese, Spanish, and Italian languages; the databases used were PubMed, Scopus, MEDLINE/Bireme (Virtual Library of Health - VLH), and Web of Science, which execute the query on the topic, keywords, or abstracts. Also, to be included, documents that were available with full-text access through CAPES, Google, or Google Scholar. Books, non-academic research, and content in languages other than the presented ones were represented as exclusion criteria.

From the resulting papers, 21 articles served as the basis for this analysis. Revealed were the year of publication, the first author’s institution nationality, topic, and disaster management phase for each study, which allow other researchers to understand the main topics regarding children’s health care in MCIs.

The topics regarding child’s health care in MCIs found in the primary studies of this review, in order of frequency, were: Disaster Response (including the following sub-topics: simulation, education, quality of care, use of technological tools, and damage analysis); Triage; and Disaster Planning. The Emergency Medicine operation was focused on harm reduction after the occurrence of an MCI. Further studies focusing on the pre-disaster and post-disaster phases are needed.

The use of triage systems is one of the most important measures in response to mass-casualty incidents (MCIs) caused by emergencies and disasters. In these systems, certain principles and criteria must be considered that can be achieved with a lack of resources. Accordingly, the present study was conducted as a systematic review to explore the principles of triage systems in emergencies and disasters world-wide.

The present study was conducted as a systematic review of the principles of triage in emergencies and disasters. All papers published from 2000 through 2019 were extracted from the Web of Science, PubMed, Scopus, Cochrane Library, and Google Scholar databases. The search for the articles was conducted by two trained researchers independently.

The classification and prioritization of the injured people, the speed, and the accuracy of the performance were considered as the main principles of triage. In certain circumstances, including chemical, biological, radiation, and nuclear (CBRN) incidents, certain principles must be considered in addition to the principles of the triage based on traumatic events. Usually in triage systems, the classification of the injured people is done using color labeling. The short duration of the triage and its accuracy are important for the survival of the injured individuals. The optimal use of available resources to protect the lives of more casualties is one of the important principles of triage systems and does not conflict with equity in health.

The design of the principles of triage in triage systems is based on scientific studies and theories in which attempts have been made to correctly classify the injured people with the maximum correctness and in the least amount of time to maintain the survival of the injured people and to achieve the most desirable level of health. It is suggested that all countries adopt a suitable and context-bond model of triage in accordance with all these principles, or to propose a new model for the triage of injured patients, particularly for hospitals in emergencies and disasters.

The objective of this study was to compare the operational viability and performance of the Sacco Triage Method (STM) to that of the Simple Triage and Rapid Treatment (START) protocol.

Following a 20-minute review of the mandated START protocol and a 20-minute training session of STM, parallel disaster exercises were conducted. Emergency responded used START in the morning and STM in the afternoon on a simulated building collapse involving 99 victims. Data were collected on the accuracy of patient assessment (START) and scoring (STM), the timeliness in clearing the scene, and me prioritization of patients leaving the scene.

The STM scoring was more accurate than START assessments at 91.7% and 71.0%, respectively. The time to clear the scene was 16% less using STM than START (53 minutes and 63 minutes, respectively). The 13 most seriously injured patients left the scene in the first seven ambulances using STM; while only two of the 13 most seriously injured patients left the scene in the first 13 ambulances under START, and the three most serious patients were transported by bus. Surveyed providers preferred START to STM and believed it to be more accurate, faster, and better able to identify the most serious patients.

Emergency responders did not implement START successfully Despite refresher training and 12 years of using START as their statewide protocol, tagging was inaccurate and patient prioritization was poor. In comparison, STM was implemented after 20 minutes of introductory training, was shown to be operationally viable, and outperformed START in all objectives.

The Sacco Triage Method (STM) is a mathematical model of resource-constrained triage. The objective of this presentation is to apply STM-Age, an age-augmented version of STM, to blunt trauma victims and compare it to Simple Triage and Rapid Treatment (START) and START-like protocols.

The objective of STM is to maximize the number of expected survivors given constraints on the timing and availability of resources. The STM incorporates estimates of time-dependent victim survival probabilities based on an initial assessment and expected deteriorations.

For the STM-Age application, an “RPM-Age” score (based on respiratory rate, pulse rate, best motor response, and coded age) was used to estimate survival probability. Logistic function-generated survival probability estimates for RPM-Age values were determined from 76,444 patients with blunt injuries from the Pennsylvania Trauma Outcome Study. The Delphi Method provided expert consensus on victim deterioration rates, and the model was solved using linear programming.

The STM-Age was compared to START and START-like methods with respect to process and to outcome, as measured by expected number of survivors, in simulated resource-constrained casualty incidents.

The RPM-Age was a more accurate predictor of survivability for blunt trauma than RPM, as measured by calibration and discrimination statistics. In simulations, STM-Age exhibited substantially more expected survivors than START and START-like protocols.

Resource-constrained triage is modeled precisely as an evidence-based, outcome-driven method (STM-Age) that maximizes expected survivors in consideration of resources. The STM-Age offers life-saving and operational advantages over current methods.