TY - JOUR
T1 - Comparing the Accuracy of Three Pediatric Disaster Triage Strategies
T2 - A Simulation-Based Investigation
AU - Cicero, Mark X.
AU - Overly, Frank
AU - Brown, Linda
AU - Yarzebski, Jorge
AU - Walsh, Barbara
AU - Shabanova, Veronika
AU - Auerbach, Marc
AU - Riera, Antonio
AU - Adelgais, Kathleen
AU - Meckler, Garth
AU - Cone, David C.
AU - Baum, Carl R.
N1 - Funding Information:
This work was supported by an Emergency Medical Services for Children Targeted Issues Grant, HRSA grant #H34MC19349
Publisher Copyright:
© Copyright Society for Disaster Medicine and Public Health, Inc. 2016.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - 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.
AB - 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.
KW - emergency responders
KW - mass casualty incidents
KW - triage
KW - vulnerable populations
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U2 - 10.1017/dmp.2015.171
DO - 10.1017/dmp.2015.171
M3 - Article
C2 - 26744228
AN - SCOPUS:84953259304
SN - 1935-7893
VL - 10
SP - 253
EP - 260
JO - Disaster medicine and public health preparedness
JF - Disaster medicine and public health preparedness
IS - 2
ER -