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The civilian validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to primary major incident triage
  1. James Vassallo1,2,
  2. Jason Smith3,4,
  3. Omar Bouamra5,
  4. Fiona Lecky5,6,
  5. Lee A Wallis1
  1. 1 Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
  2. 2 Institute of Naval Medicine, Gosport, UK
  3. 3 Department of Emergency, Derriford Hospital, Plymouth, UK
  4. 4 Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Medical Directorate, Joint Medical Command, Birmingham, UK
  5. 5 Trauma Audit and Research Network, Hope Hospital, Manchester, UK
  6. 6 Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr James Vassallo, Institute of Naval Medicine, Alverstoke, Gosport PO12 2DL, UK; vassallo{at}


Introduction Triage is a key principle in the effective management of a major incident. Existing triage tools have demonstrated limited performance at predicting need for life-saving intervention (LSI). Derived on a military cohort, the Modified Physiological Triage Tool (MPTT) has demonstrated improved performance. Using a civilian trauma registry, this study aimed to validate the MPTT in a civilian environment.

Methods Retrospective database review of the Trauma Audit and Research Network (TARN) database for all adult patients (>18 years) between 2006 and 2014. Patients were defined as Priority One if they received one or more LSIs from a previously defined list. Only patients with complete physiological data were included. Patients were categorised by the MPTT and existing triage tools using first recorded hospital physiology. Performance characteristics were evaluated using sensitivity, specificity and area under receiver operating characteristic (AUROC).

Results During the study period, 218 985 adult patients were included in the TARN database. 127 233 (58.1%) had complete data: 55.6% male, aged 61.4 (IQR 43.1–80.0) years, Injury Severity Score 9 (IQR 9–16), 96.5% suffered blunt trauma and 24 791 (19.5%) were Priority One. The MPTT (sensitivity 57.6%, specificity 71.5%) outperformed all existing triage methods with a 44.7% absolute reduction in undertriage compared with existing UK civilian methods. AUROC comparison supported the use of the MPTT over other tools (P<0.001.)

Conclusion Within a civilian trauma registry population, the MPTT demonstrates improved performance at predicting need for LSI, with the lowest rates of undertriage and an appropriate level of overtriage. We suggest the MPTT be considered as an alternative to existing triage tools.

  • triage
  • major incidents
  • life-saving interventions
  • physiological parameters

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  • Contributors JV, JES, FL and LAW conceived the study. JV conducted the analysis, supervised by JES. OB provided statistical advice and assisted with data analysis. JV drafted the manuscript and all authors contributed substantially to its revision. JV takes responsibility for the paper as a whole.

  • Competing interests None declared.

  • Ethics approval University of Cape Town. Human Research Ethics Committee. Reference 285/2013

  • Provenance and peer review Not commissioned; externally peer reviewed.