Comparing the Accuracy of Three Pediatric Disaster Triage Strategies: A Simulation-Based Investigation

Mark X. Cicero, Frank Overly, Linda Brown, Jorge Yarzebski, Barbara Walsh, Veronika Shabanova, Marc Auerbach, Antonio Riera, Kathleen Adelgais, Garth Meckler, David C. Cone, Carl R. Baum

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes. Methods We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients' expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased). Results There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (P<0.001; OR [odds ratio]: 2.03; interquartile range [IQR]: 1.30, 3.17) or CDM (P=0.02; OR: 1.76; IQR: 1.10, 2.82). JumpSTART outperformed Smart for RED patients (P=0.05; OR: 1.48; IQR: 1.01,2.17), and outperformed both Smart (P<0.001; OR: 3.22; IQR: 1.78,5.88) and CDM (P<0.001; OR: 2.86; IQR: 1.53,5.26) for YELLOW patients. Furthermore, JumpSTART outperformed CDM for BLACK patients (P=0.01; OR: 5.55; IQR: 1.47, 20.0). Conclusion Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM. (Disaster Med Public Health Preparedness.

Original languageEnglish (US)
Pages (from-to)253-260
Number of pages8
JournalDisaster medicine and public health preparedness
Issue number2
StatePublished - Apr 1 2016
Externally publishedYes


  • emergency responders
  • mass casualty incidents
  • triage
  • vulnerable populations

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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