Accuracy and feasibility of the new triage method adopted by disaster medicine service of Piemont Region compared to START method: a randomized controlled study
Maria Chiara Donati
Background: In the context of Multi casualty incidents (MCI) a triage method as accurate as possible is a very demanding challenge (1). Several different systems have been introduced during these recent decades (2-3). The study compares the new MCI Triage method adopted by Piedmont Region with the Simple Triage and Rapid Treatment (START) and Jump START (children < 8 year).
Materials and methods: this was a randomized controlled study realised in a simulation setting of multi-casualties incident (figure 1).
Figure 1- A simulated injured person
35 injured persons involved in a simulated multi-casualties incident (volunteer participants) were assessed by healthcare rescuers (nursing students and nurses). Each rescuer was randomly divided into two groups according the triage methods used: MCI triage (MCI group) if adopted the new MCI method of Piedmont Region or START and Jump START (START group).
Each triage method were explained during a lesson before the simulated rescue. Data collected were: age and gender of rescuer, if nurse or nursing student, previous experience in triage, code assigned to any injured person, time required for assessing one injured patient (seconds). Primary end point: compare the correct triage in both the groups. Secondary end points: time spent for any single injured patient, percentage of overtriage and undertriage. Finally we evaluated factors related with a correct triage (age, experience and time spent). Ethical approval was considered not necessary. All subjects were voluntaries and data collected anonymously. Statistic: numerical data were expressed as mean±standard deviation and ordinal data as percentage. Test used were Student’s T test and K square test. Linear regression with Pearson test was used for correlation between variables. P significant if < 0.05.
Results: 74 rescuers enrolled. Mean age 28.7±9.2 year. Gender: male 33.8 %, female 66,2 %. 56.7% nursing student and 43.4% nurses. Previous experience similar in both the groups (37.8% vs 21.8%, p 0.32). The MCI triage method showed a higher accuracy rate than START (88.4% vs 80.4%, p < 0.01). Similar time to value any injured subject (31.4 vs 33.7 sec, p 0.13). MCI triage had a significant lower rate of underestimation compared to START (8.9 vs 13.6%, p < 0.01) as well as overestimation (3.2% vs. 6.8%, p <0.01) (table 1).
Tab 1 - Type of error
MCI triage START P-value
Overestimation 3.7% 6.2% < 0.01
Underestimation 8.9% 13.6% < 0.01
Only time required for triage was correlated with the accuracy of MCI triage.
Conclusion: New MCI method adopted by Piedmont Region was better than START and Jump START. It worked with more accuracy and a lower risk of error. Time spent for triage was related to the accuracy of MCI method.
References: 1) Bazyar, Jafar et al. Open access Macedonian journal of medical sciences vol. 7,3 482-494. 12 Feb. 2019, doi:10.3889/oamjms.2019.119. 2) Schenker, Josef D et al. Journal of burn care & research : official publication of the American Burn Association vol. 27,5 (2006): 570-5. doi:10.1097/01.BCR.0000235450.12988.27 3) Marcussen, Christian Elleby et al. Injury vol. 53,8 (2022): 2725-2733. doi:10.1016/j.injury.2022.05.006
Mario Raviolo2, Marco Sechi2, , Giorgio Vasselli3 and Agostino Roasio1,4
1 University of Study in Nursing Science of Turin – Asti – Italy, 2 Department of Disaster Medicine and 112- Piedmont Region – Italy, 3 Researcher of Statistics, 4 Anaesthesia and Intensive Care Unit Service - “Cardinal Massaia” Hospital – Asti – Italy