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Comparison of paediatric major incident primary triage tools
  1. L A Wallis1,
  2. S Carley2
  1. 1Red Cross War Memorial Children’s Hospital, Rondebosch, Cape Town, South Africa
  2. 2Manchester Royal Infirmary, Manchester, UK
  1. Correspondence to:
 Dr S Carley
 Consultant in Emergency Medicine, Emergency Department, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; s.carley{at}


Objectives: To determine the sensitivity and specificity of paediatric major incident triage scores. The Paediatric Triage Tape (PTT), Careflight, Simple Triage and Rapid Treatment (START), and JumpSTART systems were tested.

Methods: In total, 3461 children presenting to a South African emergency department with trauma were scored using the four different methods. The sensitivity and specificity of the four scores was calculated against the Injury Severity Score (ISS), New ISS (NISS), and a modification of the Garner criteria (a measure of need for urgent clinical intervention). We also performed a Bayesian analysis of the scores against three different types of major incident.

Results: None of the tools showed high sensitivity and specificity. Overall, the Careflight score had the best performance in terms of sensitivity and specificity. The performance of the PTT was very similar. In contrast, the JumpSTART and START scores had very low sensitivities, which meant that they failed to identify patients with serious injury, and would have missed the majority of seriously injured casualties in the models of major incidents.

Conclusion: The Careflight or PTT methods of triage should be used in paediatric major incidents in preference to the jumpSTART or START methods.

  • ISS, Injury Severity Score
  • NISS, New Injury Severity Score
  • PTT, Paediatric Triage Tape
  • START, Simple Triage and Rapid Treatment

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  • Competing interests: there are no competing interests.