Vassallo, J., Beavis, J., Smith, J.E. and Wallis, L.A., 2017. Major incident triage: Derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT). Injury, 48 (5), 992-999.
Full text available as:
|
PDF
20170110_Blinded Manuscript.pdf - Accepted Version Available under License Creative Commons Attribution Non-commercial No Derivatives. 228kB | |
Copyright to original material in this document is with the original owner(s). Access to this content through BURO is granted on condition that you use it only for research, scholarly or other non-commercial purposes. If you wish to use it for any other purposes, you must contact BU via BURO@bournemouth.ac.uk. Any third party copyright material in this document remains the property of its respective owner(s). BU grants no licence for further use of that third party material. |
DOI: 10.1016/j.injury.2017.01.038
Abstract
BACKGROUND: Triage is a key principle in the effective management at a major incident. There are at least three different triage systems in use worldwide and previous attempts to validate them, have revealed limited sensitivity. Within a civilian adult population, there has been no work to develop an improved system. METHODS: A retrospective database review of the UK Joint Theatre Trauma Registry was performed for all adult patients (>18years) presenting to a deployed Military Treatment Facility between 2006 and 2013. Patients were defined as Priority One if they had received one or more life-saving interventions from a previously defined list. Using first recorded hospital physiological data (HR/RR/GCS), binary logistic regression models were used to derive optimum physiological ranges to predict need for life-saving intervention. This allowed for the derivation of the Modified Physiological Triage Tool-MPTT (GCS≥14, HR≥100, 12<RR≥22). A comparison of the MPTT and existing triage tools was then performed using sensitivities and specificities with 95% confidence intervals. Differences in performance were assessed for statistical significance using a McNemar test with Bonferroni correction. RESULTS: Of 6095 patients, 3654 (60.0%) had complete data and were included in the study, with 1738 (47.6%) identified as priority one. Existing triage tools had a maximum sensitivity of 50.9% (Modified Military Sieve) and specificity of 98.4% (Careflight). The MPTT (sensitivity 69.9%, 95% CI 0.677-0.720, specificity 65.3%, 95% CI 0.632-0.675) showed an absolute increase in sensitivity over existing tools ranging from 19.0% (Modified Military Sieve) to 45.1% (Triage Sieve). There was a statistically significant difference between the performance (p<0.001) between the MPTT and the Modified Military Sieve. DISCUSSION & CONCLUSION: The performance characteristics of the MPTT exceed existing major incident triage systems, whilst maintaining an appropriate rate of over-triage and minimising under-triage within the context of predicting the need for a life-saving intervention in a military setting. Further work is required to both prospectively validate this system and to identify its performance within a civilian environment, prior to recommending its use in the major incident setting.
Item Type: | Article |
---|---|
ISSN: | 0020-1383 |
Uncontrolled Keywords: | life-saving intervention; major incidents; physiological predictors; triage |
Group: | Faculty of Science & Technology |
ID Code: | 27462 |
Deposited By: | Symplectic RT2 |
Deposited On: | 28 Feb 2017 11:27 |
Last Modified: | 14 Mar 2022 14:03 |
Downloads
Downloads per month over past year
Repository Staff Only - |