Triaging Children in Mass Casualty – Which Tool Is Best?

October 15, 2018

Written by Clay Smith

Spoon Feed
Four mass casualty incident (MCI) triage sorting systems performed similarly in children, each 57-59% accurate. Those considered were SALT, JumpSTART, Triage Sieve, and CareFlight.

Why does this matter?
A mass casualty incident occurs when need for medical resources exceeds those available. There are different field triage sorting methods, but few have been studied for use specifically in children.

The worst kind of sorting
This was a clever way to study four different MCI triage methods in children. A convenience sample of actually injured children was prospectively assessed by a single, experienced EMS professional (apart from the routine ED evaluation) using the four sorting methods: SALT, JumpSTART, Triage Sieve, and CareFlight. Variables were meticulously recorded for all scoring systems. Then, using a computer algorithm to score them “correctly,” each patient was assigned a triage disposition: dead, expectant, delayed, mimimal, etc. They then followed all these patients to learn what happened to them in the hospital and to determine the accuracy and over- or undertriage of the 4 MCI sorting systems. They enrolled 115 patients and found that overall accuracy was the same, with all four systems with 57-59% accuracy. Undertriage was 33% with SALT, compared with 39% for the others (not statistically different). Overtriage was 4-6% with all four systems. The most common miscategorization was calling a child “minimal” when they should have been “delayed.”

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