title: Performance characteristics of five triage tools for major incidents involving traumatic injuries to children.
abstract: Context Triage tools are an essential component of the emergency response to a major incident. Although fortunately rare, mass casualty incidents involving children are possible which mandate reliable triage tools to determine the priority of treatment.
  
  
  OBJECTIVE
  To determine the performance characteristics of five major incident triage tools amongst paediatric casualties who have sustained traumatic injuries.
  
  
  METHODS
  Retrospective observational cohort study using data from 31,292 patients aged less than 16 years who sustained a traumatic injury. Data were obtained from the UK Trauma Audit and Research Network (TARN) database. Interventions Statistical evaluation of five triage tools (JumpSTART, START, CareFlight, Paediatric Triage Tape/Sieve and Triage Sort) to predict death or severe traumatic injury (injury severity score >15). Main outcome measures Performance characteristics of triage tools (sensitivity, specificity and level of agreement between triage tools) to identify patients at high risk of death or severe injury.
  
  
  RESULTS
  Of the 31,292 cases, 1029 died (3.3%), 6842 (21.9%) had major trauma (defined by an injury severity score >15) and 14,711 (47%) were aged 8 years or younger. There was variation in the performance accuracy of the tools to predict major trauma or death (sensitivities ranging between 36.4 and 96.2%; specificities 66.0-89.8%). Performance characteristics varied with the age of the child. CareFlight had the best overall performance at predicting death, with the following sensitivity and specificity (95% CI) respectively: 95.3% (93.8-96.8) and 80.4% (80.0-80.9). JumpSTART was superior for the triaging of children under 8 years; sensitivity and specificity (95% CI) respectively: 86.3% (83.1-89.5) and 84.8% (84.2-85.5). The triage tools were generally better at identifying patients who would die than those with non-fatal severe injury.
  
  
  CONCLUSIONS
  This statistical evaluation has demonstrated variability in the accuracy of triage tools at predicting outcomes for children who sustain traumatic injuries. No single tool performed consistently well across all evaluated scenarios.
authors.affiliation: Operational Research and Management Sciences Group (ORMS), Warwick Business School, University of Warwick, Coventry CV4 7AL, UK. Electronic address: charlotte.price@wbs.ac.uk.
authors.forename: C L
authors.initials: CL
authors.lastname: Price
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Brace-McDonnell
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
authors.forename: N
authors.initials: N
authors.lastname: Stallard
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bleetman
authors.affiliation: Imperial College NHS Healthcare Trust, London W2 1NY, UK; The Trauma Audit & Research Network, Manchester Medical Academic Health Sciences Centre, University of Manchester, 3rd Floor, the Mayo Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK.
authors.forename: I
authors.initials: I
authors.lastname: Maconochie
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: G D
authors.initials: GD
authors.lastname: Perkins
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D017598:Efficiency, Organizational / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054527:Mass Casualty Incidents; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods / Q000458:organization & administration; D006113:United Kingdom
keywords: Accuracy; Mass casualty; Paediatric; Prediction; Trauma; Triage