The prospective validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to major incident triage

Abstract

IntroductionTriage is a key principle in the effective management of major incidents. There is limited evidence to support existing triage tools, with a number of studies demonstrating poor performance at predicting the need for a life-saving intervention. The Modified Physiological Triage Tool (MPTT) is a novel triage tool derived using logistic regression, and in retrospective data sets has shown optimum performance at predicting the need for life-saving intervention.Materials and methodsPhysiological data and interventions were prospectively collected for consecutive adult patients with trauma (>18 years) presenting to the emergency department at Camp Bastion, Afghanistan, between March and September 2011. Patients were considered priority 1 (P1) if they received one or more interventions from a previously defined list. Patients were triaged using existing triage tools and the MPTT. Performance was measured using sensitivity and specificity, and a McNemar test with Bonferroni calculation was applied for tools with similar performance.ResultsThe study population comprised 357 patients, of whom 214 (59.9%) were classed as P1. The MPTT (sensitivity: 83.6%, 95% CI 78.0% to 88.3%; specificity: 51.0%, 95% CI 42.6% to 59.5%) outperformed all existing triage tools at predicting the need for life-saving intervention, with a 19.6% absolute reduction in undertriage compared with the existing Military Sieve. The improvement in undertriage comes at the expense of overtriage; rates of overtriage were 11.6% higher with the MPTT than the Military Sieve. Using a McNemar test, a statistically significant (p<0.001) improvement in overall performance was demonstrated, supporting the use of the MPTT over the Military Sieve.Discussion and conclusionsThe MPTT outperforms all existing triage tools at predicting the need for life-saving intervention, with the lowest rates of undertriage while maintaining acceptable levels of overtriage. Having now been validated on both military and civilian cohorts, we recommend that the major incident community consider adopting the MPTT for the purposes of primary triage.

Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts

“…The US Department of Defence Trauma Registry (DoDTR) and UK Joint Theatre Trauma Registry (JTTR) databases were scrutinised to identify patients with HI admitted to deployed MTF from 2003 to 2011. Initially, the UK JTTR inclusion criteria were patients triggering trauma team activation, but after 2007, included all patients with trauma who required Strategic Evacuation (STRATEVAC) 28. The US DoDTR inclusion criteria was admission at Role 2 or Role 3 for a traumatic injury <72 hours old or that led to patient’s death 29.…”

Triage and the Modified Physiological Triage Tool-24 (MPTT-24)

“…When the performance of existing methods of triage such as the Major Incident Medical Management and Support (MIMMS) Triage Sieve and the UK Defence Medical Services (DMS) Military Sieve is analysed, it is evident that they do not accurately identify those in need of life-saving intervention 8 9. Indeed, this is not a problem unique to UK triage tools; both the START (USA) and Careflight (Australia) tools were found to be just as inaccurate following the London 7/7 bombings 10.…”

“…In both military and civilian trauma populations, the MPTT demonstrated the greatest sensitivity, correlating with the lowest rates of undertriage (i.e, missing patients in need of life-saving interventions). However, within both populations, the improvement in sensitivity came with a reduction in specificity and had the highest rates of overtriage (classifying patients who did not require a life-saving intervention as priority 1) 8 9 13…”

2 Major incident triage and the implementation of a new triage tool, the MPTT-24

“…4 Derived specifically for this purpose, the Modified Physiological Triage Tool (MPTT) has shown the greatest sensitivity for predicting the need for lifesaving intervention, with the lowest rates of undertriage and acceptable levels of overtriage in both military and civilian populations. [5][6][7] Respiratory Rate (RR) and Glasgow Coma Scale (GCS) form key components of the MPTT and can both be time consuming to accurately measure,…”