Paediatric major incident triage: UK military tool offers best performance in predicting the need for time-critical major surgical and resuscitative intervention

Nabeela S Malik, Saisakul Chernbumroong, Yuanwei Xu, James Vassallo, Justine Lee, Christopher G Moran, Tina Newton, G Suren Arul, Janet M Lord, Antonio Belli, Damian Keene, Mark Foster, Timothy Hodgetts, Douglas M Bowley, Georgios V Gkoutos

Research output: Contribution to journalArticlepeer-review

33 Downloads (Pure)

Abstract

Background: Children are frequently injured during major incidents (MI), including terrorist attacks, conflict and natural disasters. Triage facilitates healthcare resource allocation in order to maximise overall survival. A critical function of MI triage tools is to identify patients needing time-critical major resuscitative and surgical intervention (Priority 1 (P1) status). This study compares the performance of 11 MI triage tools in predicting P1 status in children from the UK Trauma Audit and Research Network (TARN) registry.

Methods: Patients aged <16 years within TARN (January 2008-December 2017) were included. 11 triage tools were applied to patients' first recorded pre-hospital physiology. Patients were retrospectively assigned triage categories (P1, P2, P3, Expectant or Dead) using predefined intervention-based criteria. Tools' performance in <16s were evaluated within four-yearly age subgroups, comparing tool-predicted and intervention-based priority status.

Findings: Amongst 4962 patients, mortality was 1.1% (n = 53); median Injury Severity Score (ISS) was 9 (IQR 9-16). Blunt injuries predominated (94.4%). 1343 (27.1%) met intervention-based criteria for P1, exhibiting greater intensive care requirement (60.2% vs. 8.5%, p < 0.01) and ISS (median 17 vs 9, p < 0.01) compared with P2 patients. The Battlefield Casualty Drills (BCD) Triage Sieve had greatest sensitivity (75.7%) in predicting P1 status in children <16 years, demonstrating a 38.4-49.8% improvement across all subgroups of children <12 years compared with the UK's current Paediatric Triage Tape (PTT). JumpSTART demonstrated low sensitivity in predicting P1 status in 4 to 8 year olds (35.5%) and 0 to 4 year olds (28.5%), and was outperformed by its adult counterpart START (60.6% and 59.6%).

Interpretation: The BCD Triage Sieve had greatest sensitivity in predicting P1 status in this paediatric trauma registry population: we recommend it replaces the PTT in UK practice. Users of JumpSTART may consider alternative tools. We recommend Lerner's triage category definitions when conducting MI evaluations.

Original languageEnglish
Article number101100
JournalEClinicalMedicine
Volume40
Early online date23 Aug 2021
DOIs
Publication statusPublished - Oct 2021

Keywords

  • Major incident
  • Mass casualty
  • Prehospital medicine
  • Triage
  • Paediatric trauma
  • Major trauma
  • Disaster
  • Injury Severity Score
  • BCD Triage Sieve
  • CareFlight
  • START
  • MSTART
  • MPTT-24
  • RAMP
  • JumpSTART
  • MIMMS
  • Paediatric Triage Tape

Fingerprint

Dive into the research topics of 'Paediatric major incident triage: UK military tool offers best performance in predicting the need for time-critical major surgical and resuscitative intervention'. Together they form a unique fingerprint.

Cite this