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.⇓
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