title: Comparing the Accuracy of Three Pediatric Disaster Triage Strategies: A Simulation-Based Investigation.
abstract: BACKGROUND
  It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes.
  
  
  METHODS
  We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients' expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased).
  
  
  RESULTS
  There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (P<0.001; OR [odds ratio]: 2.03; interquartile range [IQR]: 1.30, 3.17) or CDM (P=0.02; OR: 1.76; IQR: 1.10, 2.82). JumpSTART outperformed Smart for RED patients (P=0.05; OR: 1.48; IQR: 1.01,2.17), and outperformed both Smart (P<0.001; OR: 3.22; IQR: 1.78,5.88) and CDM (P<0.001; OR: 2.86; IQR: 1.53,5.26) for YELLOW patients. Furthermore, JumpSTART outperformed CDM for BLACK patients (P=0.01; OR: 5.55; IQR: 1.47, 20.0).
  
  
  CONCLUSIONS
  Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM.
authors.affiliation: 1Department of Emergency Medicine,Yale School of Medicine,New Haven,Connecticut.
authors.forename: Mark X
authors.initials: MX
authors.lastname: Cicero
authors.affiliation: 2Department of Emergency Medicine,Warren Alpert School of Medicine of Brown University,Providence,Rhode Island.
authors.forename: Frank
authors.identifier: http://orcid.org/0000-0002-7702-5842
authors.initials: F
authors.lastname: Overly
authors.affiliation: 2Department of Emergency Medicine,Warren Alpert School of Medicine of Brown University,Providence,Rhode Island.
authors.forename: Linda
authors.initials: L
authors.lastname: Brown
authors.affiliation: 3Department of Medical Education,University of Massachusetts School of Medicine,Worcester,Massachusetts.
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.affiliation: 4Department of Pediatrics,University of Massachusetts School of Medicine,Worcester,Massachusetts.
authors.forename: Barbara
authors.initials: B
authors.lastname: Walsh
authors.affiliation: 5Yale Center for Analytical Sciences,Yale University,New Haven,Connecticut.
authors.forename: Veronika
authors.initials: V
authors.lastname: Shabanova
authors.affiliation: 1Department of Emergency Medicine,Yale School of Medicine,New Haven,Connecticut.
authors.forename: Marc
authors.initials: M
authors.lastname: Auerbach
authors.affiliation: 1Department of Emergency Medicine,Yale School of Medicine,New Haven,Connecticut.
authors.forename: Antonio
authors.initials: A
authors.lastname: Riera
authors.affiliation: 6Department of Emergency Medicine,Children's Hospital Colorado,Aurora,Colorado.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Adelgais
authors.affiliation: 7Department of Pediatrics University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: Garth
authors.initials: G
authors.lastname: Meckler
authors.affiliation: 1Department of Emergency Medicine,Yale School of Medicine,New Haven,Connecticut.
authors.forename: David C
authors.initials: DC
authors.lastname: Cone
authors.affiliation: 1Department of Emergency Medicine,Yale School of Medicine,New Haven,Connecticut.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Baum
mesh_terms: D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data*; D016544:Patient Simulation; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D014218:Triage / Q000379:methods* / Q000592:standards*
keywords: emergency responders; mass casualty incidents; triage; vulnerable populations