Developing a translational triage research tool: part two—evaluating the tool through a Delphi study among experts

Abstract

Background There are different prehospital triage systems, but no consensus on what constitutes the optimal choice. This heterogeneity constitutes a threat in a mass casualty incident in which triage is used during multiagency collaboration to prioritize casualties according to the injuries’ severity. A previous study has confirmed the feasibility of using a Translational Triage Tool consisting of several steps which translate primary prehospital triage systems into one. This study aims to evaluate and verify the proposed algorithm using a panel of experts who in their careers have demonstrated proficiency in triage management through research, experience, education, and practice. Method Several statements were obtained from earlier reports and were presented to the expert panel in two rounds of a Delphi study. Results There was a consensus in all provided statements, and for the first time, the panel of experts also proposed the manageable number of critical victims per healthcare provider appropriate for proper triage management. Conclusion The feasibility of the proposed algorithm was confirmed by experts with some minor modifications. The utility of the translational triage tool needs to be evaluated using authentic patient cards used in simulation exercises before being used in actual triage scenarios.

The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards

“…There are several prehospital triage systems but no consensus on what constitutes the optimal choice. This heterogeneity constitutes a threat in a mass casualty incident (MCI) in which triage is used during multiagency collaboration to prioritize casualties according to the injuries’ severity [ 2 – 5 ]. A major difference between ordinary triage of patients at hospitals´ emergency departments (ED) and utilitarian (the best for the most) prehospital triage during disasters and public health emergencies (DPHEs) lies in the available resources in the respective areas, which also may explain the variations in triage systems globally [ 6 – 12 ].…”

“…A major difference between ordinary triage of patients at hospitals´ emergency departments (ED) and utilitarian (the best for the most) prehospital triage during disasters and public health emergencies (DPHEs) lies in the available resources in the respective areas, which also may explain the variations in triage systems globally [ 6 – 12 ]. However, in both triage systems four factors, i.e., speed, precision, fairness, and compatibility are of critical value [ 3 – 5 , 12 ]. While precision might be prioritized to define a diagnosis in a resource-rich environment, such as in an ED with more time and interventional resources (e.g., laboratory, blood pressure measurements), speed is crucial in a prehospital setting, particularly in MCI, when resource availability and time are limited [ 3 , 5 – 8 ].…”

“…However, in both triage systems four factors, i.e., speed, precision, fairness, and compatibility are of critical value [ 3 – 5 , 12 ]. While precision might be prioritized to define a diagnosis in a resource-rich environment, such as in an ED with more time and interventional resources (e.g., laboratory, blood pressure measurements), speed is crucial in a prehospital setting, particularly in MCI, when resource availability and time are limited [ 3 , 5 – 8 ]. Consequently, the hastier the triage, the bigger the risk for faulty categorization, represented as under or over-triage [ 3 – 8 ].…”

“…Under-triage increases the mortality among casualties because of a prolonged time to establish an accurate diagnosis and proper interventions. Over-triage, on the other hand, results in the unnecessary use of resources, and the likelihood of increased morbidity [ 3 , 5 , 13 , 14 ]. As such, prehospital triage systems allow for a more limited precision, especially at the primary line of triage since speed remains a priority while hospital triage can often sacrifice time to maximize precision.…”

Development of outcomes for evaluating emergency care triage: a Delphi approach

“…The items to be assessed in the Delphi rounds were gathered in initial interviews with the experts in round one, and from the published literature. The Delphi approach has successfully been used when seeking consensus in emergency care [ 11 ], and when assessing questions related to triage [ 12 ]…”