title: UK Triage the validation of a new tool to counter an evolving threat.
abstract: BACKGROUND
  Major Incidents (MI) occur frequently and their unpredictable nature makes prospective research difficult and largely unethical. A key step in MI management is triage; the identification of the critically injured. Within a MI environment this is commonly performed using simple physiological ‘tools’, such as the Triage Sieve (TS). However the most commonly used tools appear to lack an evidence base. In a previous study, the authors used a military population to compare the performance of the TS to the Military Sieve (MS) at predicting need for Life-Saving Intervention (LSI). The MS differs only with the addition of a measurement of consciousness. The outcome from this study was that the MS outperformed the TS, but could be further improved with small changes to its physiological parameters, the Modified Military Sieve (MMS).
  
  
  METHODS
  Physiological data and interventions performed within the Emergency Department (ED) and Operating Theatre were prospectively collected for consecutive adult trauma patients (>18years) presenting to the ED at Camp Bastion, Afghanistan between March and September 2011. All patients receiving a LSI were considered Gold Standard Priority One. Patients were triaged using the TS, MS, MMS, START (ST) and Careflight (CF) triage tools. Sensitivities and specificities were estimated with 95% confidence intervals and differences were checked for statistical significance using a McNemar test with Bonferroni correction.
  
  
  RESULTS
  482 patients presented to the ED during the study period, sufficient data was recorded for 335 (71%) with 199 (59%) P1s. The MMS (sensitivity 68.3%, specificity 79.4%) showed an absolute increase in sensitivity over existing tools ranging from 5.0% (MS) to 23.6% (CF). There was a statistically significant difference (P = 0.0005) between the MMS and MS.
  
  
  CONCLUSIONS
  A key limitation to this study, is the use of a military cohort to validate the MMS, a tool which itself was developed using military data. The mechanism of injury also is unlikely to translate fully to the civilian population.
  
  
  CONCLUSIONS
  Within a military population, the MMS outperforms existing MI triage tools. Before it is recommended as a replacement to the existing TS in UK civilian practice, it needs to be tested in a civilian environment.
authors.forename: James
authors.initials: J
authors.lastname: Vassallo
authors.forename: Simon
authors.initials: S
authors.lastname: Horne
authors.forename: Susan
authors.initials: S
authors.lastname: Ball
authors.forename: Janine
authors.initials: J
authors.lastname: Whitley
mesh_terms: D055826:Afghan Campaign 2001-; D000465:Algorithms; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006292:Health Priorities / Q000458:organization & administration*; D006801:Humans; D054527:Mass Casualty Incidents; D008887:Military Medicine; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014218:Triage / Q000458:organization & administration*; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*