The value of three triage methodologies for critically ill patients in earthquake mass casualty_Chinese Journal of Evidence-Based Medicine

Authors：

SHAO Zilun ¹ , SONG Chengrun ² , WANG Siqi ² ,  HU Hai ^3,4

1. West China School of Public Health, Sichuan University, Chengdu 610041, P.R China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P.R China;
3. Emergency Office of West China Hospital, Sichuan University, Chengdu 610041, P.R China;
4. Comprehensive Emergency Medical Rescue Base, Chengdu 610041, P.R China;

Corresponding author：

HU Hai, Email: 412643356@qq.com

Keywords：

Triage methodology; Simple triage and rapid transport (START); Modified physiological triage tool (MPTT); Modified physiological triage tool-24 (MPTT-24); Injury severity score (ISS)

DOI：

10.7507/1672-2531.202102023

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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 other 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 evaluated using START, MPTT and MPTT-24, respectively. 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 superior to START and MPTT-24 in the evaluation of critically ill patients in mass casualty events caused by earthquakes.

Citation： SHAO Zilun, SONG Chengrun, WANG Siqi, HU Hai. The value of three triage methodologies for critically ill patients in earthquake mass casualty. Chinese Journal of Evidence-Based Medicine, 2021, 21(7): 760-765. doi: 10.7507/1672-2531.202102023 Copy

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2.	Smith RM, Dyer GS, Antonangeli K, et al. Disaster triage after the Haitian earthquake. Injury, 2012, 43(11): 1811-1815.
3.	Bazyar J, Farrokhi M, Salari A, et al. The principles of triage in emergencies and disasters: a systematic review. Prehosp Disaster Med, 2020, 35(3): 305-313.
4.	Vassallo JM, Smith JE, Wallis LA. Investigating the effects of under-triage by existing major incident triage tools. Eur J Emerg Med, 2019, 26(2): 139-144.
5.	Frykberg ER, Tepas JJ. Terrorist bombings: lessons learned from Belfast to Beirut. Ann Surg, 1988, 208(5): 569-576.
6.	Bazyar J, Farrokhi M, Khankeh H. Triage systems in mass casualty incidents and disasters: a review study with a worldwide approach. Open Access Maced J Med Sci, 2019, 7(3): 482-494.
7.	Badiali S, Giugni A, Marcis L. Testing the START triage protocol: can it improve the ability of nonmedical personnel to better triage patients during disasters and mass casualties incidents? Disaster Med Public Health Prep, 2017, 11(3): 305-309.
8.	Silvestri S, Field A, Mangalat N, et al. Comparison of START and SALT triage methodologies to reference standard definitions and to a field mass casualty simulation. Am J Disaster Med, 2017, 12(1): 27-33.
9.	Vassallo J, Beavis J, Smith JE, et al. Major incident triage: derivation and comparative analysis of the modified physiological triage tool (MPTT). Injury, 2017, 48(5): 992-999.
10.	Vassallo J, Smith JE, Wallis LA. Major incident triage and the implementation of a new triage tool, the MPTT-24. J R Army Med Corps, 2018, 164(2): 103-106.
11.	Vassallo J, Smith J, Bouamra O, et al. The civilian validation of the modified physiological triage tool (MPTT): an evidence-based approach to primary major incident triage. Emerg Med J, 2017, 34(12): 810-815.
12.	Vassallo J, Horne S, Smith JE. Triage and the modified physiological triage tool-24 (MPTT-24). BMJ Mil Health, 2020, 166(1): 33-36.
13.	Le TD, Orman JA, Stockinger ZT, et al. The military injury severity score (mISS): a better predictor of combat mortality than Injury Severity Score (ISS). J Trauma Acute Care Surg, 2016, 81(1): 114-121.
14.	叶健萍, 苏畅, 陈德源. ICU 重症创伤患者 ISS, NISS 和 APACHE Ⅱ评分, D-EFAST 病情评估及诊断价值研究. 中国现代医生, 2020, 58(23): 24-27, 33.
15.	Husum H, Strada G. Injury severity score versus new injury severity score for penetrating injuries. Prehosp Disaster Med, 2002, 17(1): 27-32.
16.	Liu S, He C. Related factors associated with earthquake inpatient mortality. Disaster Med Public Health Prep, 2020, DOI:10.1017/dmp.2020.125.
17.	Chrysou K, Halat G, Hoksch B, et al. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med, 2017, 25(1): 42.
18.	Postma IL, Weel H, Heetveld MJ, et al. Mass casualty triage after an airplane crash near Amsterdam. Injury, 2013, 44(8): 1061-1067.
19.	Mehmood A, Hung YW, He H, et al. Performance of injury severity measures in trauma research: a literature review and validation analysis of studies from low-income and middle-income countries. BMJ Open, 2019, 9(1): e023161.
20.	Ng CJ, You SH, Wu IL, et al. Introduction of a mass burn casualty triage system in a hospital during a powder explosion disaster: a retrospective cohort study. World J Emerg Surg, 2018, 13: 38.
21.	Vassallo J, Horne S, Smith JE, et al. The prospective validation of the modified physiological triage tool (MPTT): an evidence-based approach to major incident triage. J R Army Med Corps, 2017, 163(6): 383-387.
22.	Challen K, Walter D. Major incident triage: comparative validation using data from 7th July bombings. Injury, 2013, 44(5): 629-633.
23.	American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma. Resources for the optimal care of the injured veterinary patient. Available at: http://vetcot.org/wp-content/uploads/2018/02/FINAL-Resources-September-2018.pdf.
24.	Vassallo J, Smith J. Major incident triage and the evaluation of the triage sort as a secondary triage method. Emerg Med J, 2019, 36(5): 281-286.
25.	Airaksinen NK, Handolin LE, Heinänen MT. Severe traffic injuries in the Helsinki Trauma Registry between 2009-2018. Injury, 2020, 51(12): 2946-2952.
26.	Rau CS, Wu SC, Kuo PJ, et al. Polytrauma defined by the new berlin definition: a validation test based on propensity-score matching approach. Int J Environ Res Public Health, 2017, 14(9): 1045.

1. 陈博, 侯世科, 高宏伟. 强震后检伤分类及医疗需求的研究进展. 中华灾害救援医学, 2016, 4(4): 213-217.
2. Smith RM, Dyer GS, Antonangeli K, et al. Disaster triage after the Haitian earthquake. Injury, 2012, 43(11): 1811-1815.
3. Bazyar J, Farrokhi M, Salari A, et al. The principles of triage in emergencies and disasters: a systematic review. Prehosp Disaster Med, 2020, 35(3): 305-313.
4. Vassallo JM, Smith JE, Wallis LA. Investigating the effects of under-triage by existing major incident triage tools. Eur J Emerg Med, 2019, 26(2): 139-144.
5. Frykberg ER, Tepas JJ. Terrorist bombings: lessons learned from Belfast to Beirut. Ann Surg, 1988, 208(5): 569-576.
6. Bazyar J, Farrokhi M, Khankeh H. Triage systems in mass casualty incidents and disasters: a review study with a worldwide approach. Open Access Maced J Med Sci, 2019, 7(3): 482-494.
7. Badiali S, Giugni A, Marcis L. Testing the START triage protocol: can it improve the ability of nonmedical personnel to better triage patients during disasters and mass casualties incidents? Disaster Med Public Health Prep, 2017, 11(3): 305-309.
8. Silvestri S, Field A, Mangalat N, et al. Comparison of START and SALT triage methodologies to reference standard definitions and to a field mass casualty simulation. Am J Disaster Med, 2017, 12(1): 27-33.
9. Vassallo J, Beavis J, Smith JE, et al. Major incident triage: derivation and comparative analysis of the modified physiological triage tool (MPTT). Injury, 2017, 48(5): 992-999.
10. Vassallo J, Smith JE, Wallis LA. Major incident triage and the implementation of a new triage tool, the MPTT-24. J R Army Med Corps, 2018, 164(2): 103-106.
11. Vassallo J, Smith J, Bouamra O, et al. The civilian validation of the modified physiological triage tool (MPTT): an evidence-based approach to primary major incident triage. Emerg Med J, 2017, 34(12): 810-815.
12. Vassallo J, Horne S, Smith JE. Triage and the modified physiological triage tool-24 (MPTT-24). BMJ Mil Health, 2020, 166(1): 33-36.
13. Le TD, Orman JA, Stockinger ZT, et al. The military injury severity score (mISS): a better predictor of combat mortality than Injury Severity Score (ISS). J Trauma Acute Care Surg, 2016, 81(1): 114-121.
14. 叶健萍, 苏畅, 陈德源. ICU 重症创伤患者 ISS, NISS 和 APACHE Ⅱ评分, D-EFAST 病情评估及诊断价值研究. 中国现代医生, 2020, 58(23): 24-27, 33.
15. Husum H, Strada G. Injury severity score versus new injury severity score for penetrating injuries. Prehosp Disaster Med, 2002, 17(1): 27-32.
16. Liu S, He C. Related factors associated with earthquake inpatient mortality. Disaster Med Public Health Prep, 2020, DOI:10.1017/dmp.2020.125.
17. Chrysou K, Halat G, Hoksch B, et al. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med, 2017, 25(1): 42.
18. Postma IL, Weel H, Heetveld MJ, et al. Mass casualty triage after an airplane crash near Amsterdam. Injury, 2013, 44(8): 1061-1067.
19. Mehmood A, Hung YW, He H, et al. Performance of injury severity measures in trauma research: a literature review and validation analysis of studies from low-income and middle-income countries. BMJ Open, 2019, 9(1): e023161.
20. Ng CJ, You SH, Wu IL, et al. Introduction of a mass burn casualty triage system in a hospital during a powder explosion disaster: a retrospective cohort study. World J Emerg Surg, 2018, 13: 38.
21. Vassallo J, Horne S, Smith JE, et al. The prospective validation of the modified physiological triage tool (MPTT): an evidence-based approach to major incident triage. J R Army Med Corps, 2017, 163(6): 383-387.
22. Challen K, Walter D. Major incident triage: comparative validation using data from 7th July bombings. Injury, 2013, 44(5): 629-633.
23. American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma. Resources for the optimal care of the injured veterinary patient. Available at: http://vetcot.org/wp-content/uploads/2018/02/FINAL-Resources-September-2018.pdf.
24. Vassallo J, Smith J. Major incident triage and the evaluation of the triage sort as a secondary triage method. Emerg Med J, 2019, 36(5): 281-286.
25. Airaksinen NK, Handolin LE, Heinänen MT. Severe traffic injuries in the Helsinki Trauma Registry between 2009-2018. Injury, 2020, 51(12): 2946-2952.
26. Rau CS, Wu SC, Kuo PJ, et al. Polytrauma defined by the new berlin definition: a validation test based on propensity-score matching approach. Int J Environ Res Public Health, 2017, 14(9): 1045.

Chinese Journal of Evidence-Based Medicine

The value of three triage methodologies for critically ill patients in earthquake mass casualty

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