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Comparing the Accuracy of Three Pediatric Disaster Triage Strategies: A Simulation-Based Investigation

Published online by Cambridge University Press:  08 January 2016

Mark X. Cicero ,
Frank Overly Open the ORCID record for Frank Overly [Opens in a new window] ,
Linda Brown ,
Jorge Yarzebski ,
Barbara Walsh ,
Veronika Shabanova ,
Marc Auerbach ,
Antonio Riera ,
Kathleen Adelgais  and
Garth Meckler
...Show all authors
Mark X. Cicero*
Affiliation:
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
Frank Overly
Affiliation:
Department of Emergency Medicine, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island
Linda Brown
Affiliation:
Department of Emergency Medicine, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island
Jorge Yarzebski
Affiliation:
Department of Medical Education, University of Massachusetts School of Medicine, Worcester, Massachusetts
Barbara Walsh
Affiliation:
Department of Pediatrics, University of Massachusetts School of Medicine, Worcester, Massachusetts
Veronika Shabanova
Affiliation:
Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
Marc Auerbach
Affiliation:
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
Antonio Riera
Affiliation:
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
Kathleen Adelgais
Affiliation:
Department of Emergency Medicine, Children’s Hospital Colorado, Aurora, Colorado
Garth Meckler
Affiliation:
Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada.
David C. Cone
Affiliation:
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
Carl R. Baum
Affiliation:
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
*
Correspondence and reprint requests to Mark X. Cicero, Department of Emergency Medicine, Yale School of Medicine, 100 York Street Suite 1F, New Haven, CT 06511 (e-mail: mark.cicero@yale.edu).
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Abstract

Background

It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes.

Methods

We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients’ expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased).

Results

There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (P<0.001; OR [odds ratio]: 2.03; interquartile range [IQR]: 1.30, 3.17) or CDM (P=0.02; OR: 1.76; IQR: 1.10, 2.82). JumpSTART outperformed Smart for RED patients (P=0.05; OR: 1.48; IQR: 1.01,2.17), and outperformed both Smart (P<0.001; OR: 3.22; IQR: 1.78,5.88) and CDM (P<0.001; OR: 2.86; IQR: 1.53,5.26) for YELLOW patients. Furthermore, JumpSTART outperformed CDM for BLACK patients (P=0.01; OR: 5.55; IQR: 1.47, 20.0).

Conclusion

Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM. (Disaster Med Public Health Preparedness. 2016;10:253–260)

Keywords

triageemergency respondersmass casualty incidentsvulnerable populations
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Issue 2 , April 2016 , pp. 253 - 260
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2016 

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