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MAJOR INCIDENT TRIAGE: THE CIVILIAN VALIDATION OF THE MODIFIED PHYSIOLOGICAL TRIAGE TOOL
  1. JE Smith1,4,
  2. J Vassallo2,3
  1. 1Emergency Department, Plymouth Hospital, Plymouth, UK
  2. 2Division of Emergency Medicine, University of Cape Town, Cape Town, South africa
  3. 3Institute of Naval Medicine, Gosport, UK
  4. 4Academic Department of Military Emergency Medicine (Research & Academia), Birmingham, UK

Abstract

Objectives & Background Triage, the process of categorising patients based on clinical acuity, is a key principle in the effective management of a major incident (MI). Existing triage systems have so far demonstrated limited performance. The Modified Physiological Triage Tool (MPTT) was derived using a military cohort and significantly demonstrated improved performance. Within the adult civilian population, with a predominance to an older population and a blunt mechanism, no such work has been undertaken. The purpose of this study was to perform a comparative analysis and validation of the MPTT within a civilian environment.

Methods The Trauma Audit Research Network (TARN) database was interrogated to identify all adult patients (≥18 years) treated at a single hospital between 2006 and 2014. Patients were defined as Priority One (P1) if they received a life-saving intervention from a previously defined list. Only patients with complete physiological data were included in the analysis. Using first recorded physiological data (HR/RR/GCS/SBP), patients were categorised as P1 or Not-P1 by the MPTT (12 >RR≤ 22, HR≥100, GCS<14) and existing MI triage tools. Performance characteristics of all tools were evaluated using sensitivity, specificity and AUROC, and rates of over/under-triage compared. AUROC were compared for tools with similar performance.

Results During 2006–2014, 218,453 adult trauma patients were identified. 129,647 (59.3%) had complete data and were included: 55% male, median age 61 years and median Injury Severity Score 9. Blunt trauma predominated (96.5%), with falls<2 m the most common mechanism (53.9%). 25,452 patients (19.6%) were identified as P1. The MPTT outperformed all existing triage methods with the highest sensitivity (58.1%) and demonstrated an absolute reduction in under-triage of 44.5% when compared to the Triage Sieve. With an AUROC increase of 1.3, ROC comparison demonstrated significance between MPTT and Modified Military Sieve (X2=83.91, p<0.001), statistically supporting the use of the MPTT.

Conclusion This study has demonstrated the performance of the MPTT (a tool derived using a military cohort) in a civilian environment, where it has been shown to outperform all existing MI triage systems in its ability to predict need for life-saving intervention. As a result of this validation, its use within a civilian major incident context is recommended.

Figure 1

Receiver Operator Characteristic Curves for MPTT & Existing MI triage tools.

Table 1

Sensitivity Analysis

  • Trauma

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