Paediatric major incident triage: UK military tool offers best performance in predicting the need for time-critical major surgical and resuscitative intervention.

Nabeela S Malik,Timothy Hodgetts,Douglas M Bowley,G Suren Arul,Georgios V Gkoutos,Janet M Lord,Christopher G Moran,Justine Lee,James Vassallo,Saisakul Chernbumroong,Antonio Belli,Damian Keene,Yuanwei Xu,Tina Newton,Mark Foster

doi:10.1016/j.eclinm.2021.101100

Abstract

BackgroundChildren are frequently injured during major incidents (MI), including terrorist attacks, conflict and natural disasters. Triage facilitates healthcare resource allocation in order to maximise overall survival. A critical function of MI triage tools is to identify patients needing time-critical major resuscitative and surgical intervention (Priority 1 (P1) status). This study compares the performance of 11 MI triage tools in predicting P1 status in children from the UK Trauma Audit and Research Network (TARN) registry.MethodsPatients aged <16 years within TARN (January 2008-December 2017) were included. 11 triage tools were applied to patients’ first recorded pre-hospital physiology. Patients were retrospectively assigned triage categories (P1, P2, P3, Expectant or Dead) using predefined intervention-based criteria. Tools’ performance in <16s were evaluated within four-yearly age subgroups, comparing tool-predicted and intervention-based priority status.FindingsAmongst 4962 patients, mortality was 1.1% (n = 53); median Injury Severity Score (ISS) was 9 (IQR 9–16). Blunt injuries predominated (94.4%). 1343 (27.1%) met intervention-based criteria for P1, exhibiting greater intensive care requirement (60.2% vs. 8.5%, p < 0.01) and ISS (median 17 vs 9, p < 0.01) compared with P2 patients. The Battlefield Casualty Drills (BCD) Triage Sieve had greatest sensitivity (75.7%) in predicting P1 status in children <16 years, demonstrating a 38.4–49.8% improvement across all subgroups of children <12 years compared with the UK's current Paediatric Triage Tape (PTT). JumpSTART demonstrated low sensitivity in predicting P1 status in 4 to 8 year olds (35.5%) and 0 to 4 year olds (28.5%), and was outperformed by its adult counterpart START (60.6% and 59.6%).InterpretationThe BCD Triage Sieve had greatest sensitivity in predicting P1 status in this paediatric trauma registry population: we recommend it replaces the PTT in UK practice. Users of JumpSTART may consider alternative tools. We recommend Lerner's triage category definitions when conducting MI evaluations.

Highlights

Children are often injured during major incidents (MI) including natural disasters, conflict and terrorist attacks, where their immediate needs exceed the resources available to treat them [1À4]
Selection of a triage tool for use at scene is an important aspect of disaster planning, enabling patients to be prioritised for treatment and onward transfer, those in need of immediate life-saving intervention[1,3,4]
Care of children during MIs is challenging and emotive, and specialist paediatric trauma resources are less available than adult services

Summary

Introduction

Children are often injured during major incidents (MI) including natural disasters, conflict and terrorist attacks, where their immediate needs exceed the resources available to treat them [1À4]. A critical function of MI triage tools is to identify patients needing time-critical major resuscitative and surgical intervention (Priority 1 (P1) status). This study compares the performance of 11 MI triage tools in predicting P1 status in children from the UK Trauma Audit and Research Network (TARN) registry. Tools’ performance in

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