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Investigating the effects of under-triage by existing major incident triage tools

Vassallo, James M.a,b; Smith, Jason E.c,d; Wallis, Lee A.a

European Journal of Emergency Medicine: April 2019 - Volume 26 - Issue 2 - p 139–144
doi: 10.1097/MEJ.0000000000000513

Objectives Triage is a key principle in the effective management of a major incident. Its effectiveness is a balance between identifying those in need of life-saving intervention, and those triaged incorrectly as either needing/not needing a life-saving intervention. The primary aim of this study was to report mortality in those under-triaged by existing major incident triage tools. Secondary aims were to report the ability of triage tools at identifying serious injury by body region (defined as an Abbreviated Injury Scale severity score≥3).

Patients and methods Retrospective database analysis of the UK Trauma Audit Research Network for all adult patients (≥18 years) between 2006 and 2014. Patients were defined as priority one using a previously published list. Using the first recorded hospital physiology, patients were categorized by the Modified Physiological Triage Tool (MPTT), National Ambulance Resilience Unit (NARU) Sieve and the Major Incident Medical Management and Support (MIMMS) Triage Sieve. Categorical and continuous data were analyzed using a χ2-test and Mann–Whitney U-test respectively.

Results During the study period, 218 985 adult patients met the Trauma Audit Research Network inclusion criteria, with 24 791 (19.5%) priority one patients, of which 70% were male with a median age of 51 (33–71) years and injury severity score of 16 (9–25). The MPTT showed the lowest rate of under-triage (42.4%, P<0.001). Compared with existing methods, the MPTT under-triage population had significantly lower mortality (5.7%, P<0.001) with significantly fewer serious thorax and head injuries under-triaged than both the NARU Sieve and MIMMS Triage Sieve (P<0.001).

Conclusion This study has defined the implications of under-triage in the context of a major trauma population. The MPTT misses fewer severely injured patients, with a significant reduction in mortality. We suggest the MPTT to be considered as an alternative to existing primary major incident triage tools.

aDivision of Emergency Medicine, University of Cape Town, Cape Town, South Africa

bInstitute of Naval Medicine, Gosport

cEmergency Department, Derriford Hospital, Plymouth

dAcademic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Medical Directorate, Birmingham, UK

Correspondence to James M. Vassallo, MBBS, Institute of Naval Medicine, Alverstoke PO12 2DL, UK Tel: +44 175 243 7629; fax: +44 845 155 8235; e-mail:

Received June 5, 2017

Accepted October 4, 2017

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