title: A pilot study examining the speed and accuracy of triage for simulated disaster patients in an emergency department setting: Comparison of a computerized version of Canadian Triage Acuity Scale (CTAS) and Simple Triage and Rapid Treatment (START) methods.
abstract: OBJECTIVE
  To compare emergency department triage nurses' time to triage and accuracy of a simulated mass casualty incident (MCI) population using a computerized version of CTAS or START systems.
  
  
  METHODS
  This pilot study was a prospective trial using a convenience sample. A total of 20 ED triage nurses, 10 in each arm of the study, were recruited. The paper-based questionnaire contained nine simulated MCI vignettes. An expert panel arrived at consensuses on the wording of the vignettes and created a standard triage score from which to compare the study participants. Linear regression and chi-squared test were used to examine the time to triage and accuracy of triage, respectively.
  
  
  RESULTS
  The mean triage time for computerized CTAS (cCTAS) and START were 138 seconds/patient and 33 seconds/patient, respectively. The effect size due to triage method was 108 seconds/patient (95% CI 83-134 seconds/patient). The cumulative triage accuracy for the cCTAS and START tools were 70/90 (77.8%) and 65/90 (72.2%), respectively. The percent difference between cumulative triage was 6% (95% CI -19-8%).
  
  
  CONCLUSIONS
  Triage nurses completed START triage 105 seconds/patient faster when compared to cCTAS triage and a similar level of accuracy between the two methods was achieved. However, when the typing time is taken into consideration cCTAS took 45 seconds/patient longer. The use of either CTAS or START in the ED during a MCI may be reasonable but choosing one method over another is not justified from this investigation.
authors: *Department of Family Medicine,University of Calgary,Calgary,AB.
authors: Gwynn
authors: G
authors: Curran-Sills
authors: †Department of Emergency Medicine,University of Alberta and Translational Medicine,Universita' Degli Studi del Piemonte Orientale,Vercelli,Italy.
authors: Jeffrey M
authors: JM
authors: Franc
mesh_terms: D000328:Adult; D003198:Computer Simulation; D004189:Disaster Planning / Q000379:methods*; D016529:Emergency Nursing / Q000592:standards* / Q000639:trends; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents / Q000401:mortality; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011446:Prospective Studies; D013997:Time Factors; D014218:Triage
keywords: Canadian Triage and Acuity Score; Simple Treatment and Rapid Triage; emergency department triage; mass casualty incident; primary triage; secondary triage