Journal of Angiotherapy
Integrative Biomedical Research | Online ISSN  2207-872X
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Contents Vol 8 (9)

Comparative Accuracy of Global Triage Systems in Mass Casualty and Emergency Care: A Systematic Review

Ali Ali Alotaibi 1, Awadh Hamdi Alhafi 1, Ahmed Nijr Owaidh Alrahimi 1, Faisal Saed Almutairi 1, Ali Mohammed Al Otaif 1, Khalid ASSAF Muhammad Almotairi 1, Sultan Mesfer Alotaibi 1, Yousef Mesmer Al-Mutairi 1, Aed Ataallah Al-Mutairi 1, Fawaz Nasser Dhaifallah Alotaibi 1, Saqer Aljazirah 1, Nayef Lahiq Al-Otaibi 1

+ Author Affiliations

Journal of Angiotherapy 8 (9) 1-8 https://doi.org/10.25163/angiotherapy.8910272

Submitted: 08 July 2024 Revised: 15 September 2024  Published: 17 September 2024 

Abstract

Triage systems play a vital role in patient allocation in emergency and mass casualty incident (MCI) scenarios, on the basis of efficient use of resources and early intervention. This systematic review contrasts the accuracy of nine triage systems used worldwide: Simple Triage and Rapid Treatment (START), Modified START (mSTART), Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT), SMART, CareFlight, Amberg-Schwandorf Algorithm for Primary Triage (ASAV), Modified Physiological Triage Tool (MPTT), Sieve, and Emergency Severity Index (ESI). Systematic PubMed, Scopus, Web of Science, Cochrane Library, ScienceDirect, Medlib, and Google Scholar search from 2000 through 2022 resulted in 32 studies. Accuracy measures, including sensitivity, specificity, positive/negative predictive values, overall accuracy, over-triage, and under-triage, were extremely variable. SMART was the most accurate (93%), but ESI had the highest critical cases (100% sensitivity at Level 1). Over-triage (to 53%) and under-triage (to 57.6%) are unfortunate, context-dependent on provider training, incident type, and system design. There is no universal triage system, calling for solutions specific to the context. Solutions include standardized approaches, augmented training, blended methods, and technology incorporation to maximally optimize triage performance and maximize patient outcomes in diverse emergency circumstances.

Keywords: Triage systems, mass casualty incidents, accuracy, emergency care, patient prioritization.

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