Objective Currently, simple triage and rapid transport (START) is widely used as a method to evaluate the severity of mass casualty events in a disaster. Modified physiological triage tool (MPTT) and modified physiological triage tool-24 (MPTT-24) are newly introduced triage methodologies that may offer improvements over START. However, the feasibility and accuracy of these two methods cannot be adequately assessed without sufficient data support, whether in earthquakes or others disasters. Our study aimed to analyze the value of the three triage methodologies in mass casualty events due to earthquakes.Methods A total of 36 604 injured patients from the West China Hospital database were each evaluated using START, MPTT and MPTT-24. The triage methodologies were then evaluated based on death and ICU acceptance, using the area under the receiver-operator curve (AUC). The sensitivity and specificity of the three methodologies were compared under different standards and correlations with the injury severity score (ISS) were analyzed. Results For deaths, the AUCs for the triage methodologies were 0.711, 0.775 and 0.686 for START, MPTT and MPTT-24, respectively. For ICU acceptance, the AUCs of the triage methodologies after correction for bias were 0.579, 0.618 and 0.603. The correlation coefficients of the triage methodologies and ISS score were 0.041, 0.087 and 0.115.Conclusions MPTT is better than START and MPTT-24 in the evaluation of critically ill patients in mass casualty events caused by earthquakes.