New tool has higher sensitivity in major-incident triage


By Will Boggs MD

NEW YORK (Reuters Health) - The Modified Physiological Triage Tool (MPTT) is more sensitive than other such tools to the need for life-saving intervention during major incidents from battlegrounds to civilian settings.

"Primary triage is about not missing the sickest - therefore, a higher rate of over-triage needs to be accepted in order to avoid missing these patients,” said Dr. James Vassallo from the Institute of Naval Medicine, in Gosport, UK.

“The MPTT we believe is the optimum simple physiological assessment for this purpose with the lowest rate of under-triage and acceptable levels of over-triage (well within those limits described by the American College of Surgeons for field triage to a Level 1 center),” he told Reuters Health by email.

The MPTT was derived from a military cohort using logistic regression methodology with the purpose of identifying those in need of life-saving intervention. In retrospective studies, it has performed better than existing triage methods.

Dr. Vassallo and colleagues compared the performance of the MPTT with that of other triage tools in their prospective study of 357 patients presenting to the emergency department; 60% were deemed priority 1, that is, in need of a life-saving intervention.

The MPTT was more sensitive than all other existing triage tools, at 83.6%. This represented an absolute increase of 14.9% over the Military Sieve, 19.6% over the Modified Military Sieve, and 26.1% over the best-performing civilian triage tool (START), the team reports in the Journal of the Royal Army Medical Corps, online July 23.

The MPTT also had the lowest specificity (51.0%), which resulted in the highest rate of over-triage (28.1%).

During the July 7, 2005, London bombings, the city “tolerated an over-triage rate of 64% - though this is with 4 Level 1 trauma centers and a number of additional EDs,” Dr. Vassallo said. “Whether this level could be tolerated in more rural settings is questionable - therefore, the need for effective secondary triage.”

“We must remember that triage is a dynamic process - it needs to be repeated and changed as required,” he explained. “Secondary triage, when it is performed, must contribute to this process - existing studies demonstrate that by keeping it a purely physiological process, we are unlikely to add much more to this process (in terms of sensitivity/specificity), and therefore we need to explore a more detailed method (such as repeating the field triage process).”

Dr. Vassallo added, "The views expressed here, and also within our manuscript, represent our personal opinions and are not necessarily reflective of that of the Ministry of Defence or the UK Defence Medical Services.”


J R Army Med Corps 2017.

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