Comparison of START triage categories to emergency department triage levels to determine need for urgent care and to predict hospitalization

Hong, Rick; Sexton, Ryan; Sweet, B. H.; Carroll, Gerard; Tambussi, Caitlin; Baumann, Brigitte M.

doi:10.5055/ajdm.2015.0184

Cited by 10 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No matter what the chosen interval is, there is always gray areas (compare the casualty with RR = 29/min vs > 30/min). The interval chosen for the final system was just the interval that covered the whole spectrum of the four alternatives ( START/mSTART: no lower limit, just > 30/min, FDNY-START; 10–30/min, MPTT: 11–22/min, and TS: 9–30/min ) [ 13 , 45 , 46 , 64 ].…”

Section: Discussionmentioning

confidence: 99%

“…Historically, a palpable radial pulse has been equated to a systolic blood pressure (SBP) of > 80–90 mmHg [ 1 , 13 , 18 , 45 ] and an SBP of < 90 mmHg is widely taught as a sign of shock [ 68 ] or the limit of clinical hypotension. The broad term of shock is applicable to the trauma casualty primarily as a function of hypovolemia due to major hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A translational triage research development tool: standardizing prehospital triage decision-making systems in mass casualty incidents

Khorram‐Manesh

Nordling

Carlström

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background There is no global consensus on the use of prehospital triage system in mass casualty incidents. The purpose of this study was to evaluate the most commonly used pre-existing prehospital triage systems for the possibility of creating one universal translational triage tool. Methods The Rapid Evidence Review consisted of (1) a systematic literature review (2) merging and content analysis of the studies focusing on similarities and differences between systems and (3) development of a universal system. Results There were 17 triage systems described in 31 eligible articles out of 797 identified initially. Seven of the systems met the predesignated criteria and were selected for further analysis. The criteria from the final seven systems were compiled, translated and counted for in means of 1/7’s. As a product, a universal system was created of the majority criteria. Conclusions This study does not create a new triage system itself but rather identifies the possibility to convert various prehospital triage systems into one by using a triage translational tool. Future research should examine the tool and its different decision-making steps either by using simulations or by experts’ evaluation to ensure its feasibility in terms of speed, continuity, simplicity, sensitivity and specificity, before final evaluation at prehospital level.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A translational triage research development tool: standardizing prehospital triage decision-making systems in mass casualty incidents

Khorram‐Manesh

Nordling

Carlström

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…Regarding over-triage, all patients but 2 (4.2%) of triage levels I and II were admitted to the ICU. Previous studies showed that prehospital triage had a high over-triage rate [ 6 – 8 ]. Kahn et al conducted an outcome assessment after a true disaster to determine whether START triage levels match patients’ actual clinical status [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…A responder first identifies walking wounded patients (green), followed by sorting patients into immediate (red) and delay (yellow) based on respiratory rate, perfusion, and mental status. A previous study, which evaluated the performance of START via a retrospective review, showed poor agreement between triage levels and outcomes [ 6 – 8 ]. There were concerns about the insufficiency of using START triage in mass burn casualty (MBC) incidents [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Introduction of a mass burn casualty triage system in a hospital during a powder explosion disaster: a retrospective cohort study

You

et al. 2018

World J Emerg Surg

View full text Add to dashboard Cite

BackgroundThe triage system used during an actual mass burn casualty (MBC) incident is a major focus of concern. This study introduces a MBC triage system that was used by a burn center during an actual MBC incident following a powder explosion in New Taipei City, Taiwan.MethodsThis study retrospectively analyzed data from patients who were sent to the study hospital during a MBC incident. The patient list was retrieved from a national online management system. A MBC triage system was developed at the study hospital using the following modifiers: consciousness, breathing, and burn size. Medical records were retrieved from electronic records for analysis. Patient outcomes consisted of emergency department (ED) disposition and intervention.ResultsThe patient population was predominantly female (56.3%), with an average age of 24.9 years. Mean burn sizes relative to the TBSA of triage level I, II, and III patients were 57.9%, 40.5%, and 8.7%, respectively. ICU length of stay differed markedly according to triage level (mean days for levels I vs II vs III: 57.9 vs 39.9 vs 2.5 days; p < 0.001). Triage system levels I and II indicate ICU admission with a sensitivity of 93.9% (95%CI 80.4–98.3%) and a specificity of 86.7% (62.1–96.3%).Overall, 3 (6.3%) patients were under-triaged. Two (4.2%) patients were over-triaged. Sixteen (48.5%) and 21 (63.6%) patients of triage levels I and II received endotracheal intubation and central venous catheterization, respectively. Sorting of the study population with simple triage and rapid treatment (START) showed great sensitivity (100.0%) but poor specificity (53.3%). The Taiwan Triage and Acuity Scale (TTAS) presented 87.9% sensitivity and 93.9% specificity.ConclusionsThe current MBC triage algorithm served as a good indicator of ED disposition but might have raised excessive immediate attention and had the potential to exhaust the available resources. These findings add to our knowledge of the MBC triage system and should help future researchers in adjusting the triage criteria to fit actual disasters.

show abstract

Organizing the Trauma Team in the Military and Civilian Settings

Yaffe

Gupta

Weisbrod³

et al. 2018

Managing Dismounted Complex Blast Injuries in Military &Amp; Civilian Settings

View full text Add to dashboard Cite

Comparison of START triage categories to emergency department triage levels to determine need for urgent care and to predict hospitalization

Abstract: ESI better identified patients with abnormal vital signs, those who needed emergent interventions, and those admitted than START.

Cited by 10 publications

References 0 publications

A translational triage research development tool: standardizing prehospital triage decision-making systems in mass casualty incidents

A translational triage research development tool: standardizing prehospital triage decision-making systems in mass casualty incidents

Introduction of a mass burn casualty triage system in a hospital during a powder explosion disaster: a retrospective cohort study

Organizing the Trauma Team in the Military and Civilian Settings

Contact Info

Product

Resources

About