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Research Paper Overview

  • Title: The BCD Triage Sieve outperforms all existing major incident triage tools: Comparative analysis using the UK national trauma registry population

  • Authors: Nabeela S. Malik, Saisakul Chernbumroong, Yuanwei Xu, James Vassallo, Justine Lee, Douglas M. Bowley, Timothy Hodgetts, Christopher G Moran, Janet M Lord, Antonio Bell, Damian Keen, Mark Foster, Georgios V Gkoutos

Article Information

  • Institutions: Various including NIHR Surgical Reconstruction and Microbiological Research Centre, University of Birmingham, and Royal Centre for Defence Medicine.

  • Publication Details: Received on 22 December 2020, Revised on 19 April 2021, Accepted on 20 April 2021.

  • Funding: National Institute for Health Research (NIHR).

  • Keywords: Major incident, Mass casualty, Prehospital medicine, Triage, Major trauma, Disaster.

Background

  • Natural disasters, conflict, and terrorism cause significant global deaths and disabilities.

  • Triage is essential for providing timely medical care to patients in need, particularly to ensure life-saving treatments for high-priority patients (P1).

  • An effective triage tool should have high sensitivity for identifying P1 cases while minimizing false positives (over-triage).

Methods

  • Study utilized the UK Trauma Audit and Research Network (TARN) registry data from January 2008 to December 2017.

  • Participants: Patients aged 16+ were included, totaling 195,709; mortality rate was 7.0%.

  • Ten triage tools were evaluated for their ability to accurately predict P1 status based on first recorded pre-hospital physiology.

  • Triage categories defined: P1 (Immediate), P2 (Urgent), P3, Expectant, and Dead based on intervention criteria.

Key Findings

  • Patients Evaluated: 22,144 patients met P1 criteria, exhibiting higher mortality (12.8% vs. 5.0% for P2).

  • Injury Severity Score (ISS): Median ISS for P1 patients was 21, and 97.1% sustained blunt injuries.

  • The BCD Triage Sieve was the most effective tool with:

    • Sensitivity: 70.4%

    • Over-triage: 70.9%

    • AUC: 0.680

  • Other tools like NARU Triage Sieve showed lower effectiveness (Sensitivity: 44.9%, AUC: 0.666).

Implications

  • BCD Triage Sieve is recommended to replace NARU Triage Sieve as the primary triage tool in the UK due to superior performance in predictive accuracy for P1 patients.

  • Validated definitions for triage categories are suggested for evaluating major incidents in the future.

Recommendations

  • Future evaluations of triage systems should use consensus-derived definitions to ensure standardized assessments.

  • Addressing the challenges for applying triage in the elderly, as all tools performed poorly in this demographic.

Discussion

  • Importance of careful triage tool selection, especially for major incidents which can overwhelm healthcare resources.

  • The study validates conclusions through a strong patient population sample, emphasizing the need for operational guidelines.

  • Potential future work includes exploring technology use in triage applications.

Conclusion

  • This study demonstrates that the BCD Triage Sieve could significantly improve the efficiency of emergency medical services in major incidents by better identifying those in urgent need of care.