Comparison of Outcome Tools Used to Test Mass-Casualty Algorithms in the Pediatric Population

2021 ◽  
pp. 1-5
Author(s):  
J. Joelle Donofrio ◽  
Alaa Shaban ◽  
Amy H. Kaji ◽  
Genevieve Santillanes ◽  
Mark X. Cicero ◽  
...  
Keyword(s):  
Injury Severity ◽  
Pediatric Population ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Study Objective ◽  
Large Numbers ◽  
Triage Category ◽  
Level I ◽  
Outcome Tool ◽  
Trauma Activation

Abstract Introduction: Mass-casualty incident (MCI) algorithms are used to sort large numbers of patients rapidly into four basic categories based on severity. To date, there is no consensus on the best method to test the accuracy of an MCI algorithm in the pediatric population, nor on the agreement between different tools designed for this purpose. Study Objective: This study is to compare agreement between the Criteria Outcomes Tool (COT) to previously published outcomes tools in assessing the triage category applied to a simulated set of pediatric MCI patients. Methods: An MCI triage category (black, red, yellow, and green) was applied to patients from a pre-collected retrospective cohort of pediatric patients under 14 years of age brought in as a trauma activation to a Level I trauma center from July 2010 through November 2013 using each of the following outcome measures: COT, modified Baxt score, modified Baxt combined with mortality and/or length-of-stay (LOS), ambulatory status, mortality alone, and Injury Severity Score (ISS). Descriptive statistics were applied to determine agreement between tools. Results: A total of 247 patients were included, ranging from 25 days to 13 years of age. The outcome of mortality had 100% agreement with the COT black. The “modified Baxt positive and alive” outcome had the highest agreement with COT red (65%). All yellow outcomes had 47%-53% agreement with COT yellow. “Modified Baxt negative and <24 hours LOS” had the highest agreement with the COT green at 89%. Conclusions: Assessment of algorithms for triaging pediatric MCI patients is complicated by the lack of a gold standard outcome tool and variability between existing measures.

Results of in-hospital triage in 17 mass casualty trainings: Underestimation of life-threatening injuries and need for re-triage

2013 ◽  
Vol 8 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Christian Kleber, MD ◽  
Detlef Cwojdzinski ◽  
Markus Strehl ◽  
Stefan Poloczek, MD, MPH ◽  
Norbert P. Haas, MD
Keyword(s):  
Injury Severity ◽  
Mass Casualty ◽  
Diagnostic Tools ◽  
Triage Category ◽  
Number Of Patients ◽  
Key Factor ◽  
Life Threatening ◽  
Level I ◽  
Disaster Training ◽  
Life Threat

Background: In-hospital triage is the key factor for successful management of an overwhelming number of patients in lack of treatment capacity. The main goal of in-hospital triage is to identify casualties with life-threatening injuries and to allocate immediate medical aid. For the first time, we evaluate the quality of in-hospital triage in the German capital Berlin.Methods: In this prospective observational study of 17 unheralded external mass casualty trainings for Berlin disaster hospitals in 2010/2011, we analyzed the in-hospital triage of 601 rouged casualty actors. Evaluation was performed by structured external survey and interview of the casualty actors after the disaster training. In 93 percent (n = 558), complete data were available and suitable for statistical analysis.Results: The primary triage category was allocated correctly to 61 percent (n = 338) of the simulated injury severity. The following measurements were performed: anamnesis in 77 percent, physical examination 71 percent, blood pressure in 68 percent, heart rate in 61 percent, and oxygen saturation in 25 percent. Additive radiological diagnostics were used: 38 percent X-ray, 16 percent computer tomography, and 7 percent ultrasound. On an average, 1.6 ± 1.2 diagnostic tools were used to allocate injury severity to rouged casualties. Of all the rouged casualties, 24 percent overtriage and 16 percent undertriage were observed. Overtriage was significantly infrequent in level I trauma centers (p = 0.03). Of the patients with life-threatening injuries, 18 percent was undertriaged. Of the 62 percent with secondary right allocation to triage category, re-triage was only used in 4 percent.Conclusion: The accuracy of in-hospital triage is low (61 percent). Predominately, the problem of overtriage (24 percent) due to insufficient triage training in contrast to undertriage (16 percent) occurs. The diagnostic triage adjuncts, ultrasound and re-triage, should be routinely used to lower the rate of undetected life threat in mass casualty incidents. Furthermore, a standardized training program and triage algorithm for in-hospital triage should be established.

Mass Casualty Triage: An Evaluation of the Science and Refinement of a National Guideline

2011 ◽  
Vol 5 (2) ◽  
pp. 129-137 ◽  
Author(s):  
E. Brooke Lerner ◽  
David C. Cone ◽  
Eric S. Weinstein ◽  
Richard B. Schwartz ◽  
Phillip L. Coule ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
National Guideline ◽  
Public Health Preparedness ◽  
The Core ◽  
Individual Assessment ◽  
Triage Category

ABSTRACTMass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.(Disaster Med Public Health Preparedness. 2011;5:129-137)

Planning for a medical surge incident: Is rehabilitation the missing link?

2017 ◽  
Vol 12 (3) ◽  
pp. 157-165
Author(s):  
Kay Vonderschmidt, DSc, MPA, MS, NR-P
Keyword(s):  
Injury Severity ◽  
Disaster Planning ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mixed Methods Study ◽  
Assessment Tools ◽  
Patient Acuity ◽  
Rehabilitative Care ◽  
Standard Patient ◽  
Rapid Treatment

This mixed methods study explored surge planning for patients who will need rehabilitative care after a mass casualty incident. Planning for a patient surge incident typically considers only prehospital and hospital care. However, in many cases, disaster patients need rehabilitation for which planning is often overlooked. The purpose of this study was to explore this hidden dimension of patient rehabilitation for surge planning and preparedness and ask:1. To what extent can an analysis of standard patient acuity assessment tools [Simple Triage and Rapid Treatment and Injury Severity Score] be used to project future demand for admission to rehabilitative care?2. What improvements to medical disaster planning are needed to address patient surge related to rehabilitation?This study found that standard patient benchmarks can be used to project demand for rehabilitation following a mass casualty incident, and argues that a reconceptualization of surge planning to include rehabilitation would improve medical disaster planning.

Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma

2016 ◽  
Vol 82 (12) ◽  
pp. 1227-1231 ◽  
Author(s):  
Aaron M. Lewis ◽  
Salvador Sordo ◽  
Leonard J. Weireter ◽  
Michelle A. Price ◽  
Leopoldo Cancio ◽  
...  
Keyword(s):  
Public Transportation ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Incident Management ◽  
Trauma Centers ◽  
Select Group ◽  
Level Ii ◽  
American College Of Surgeons ◽  
Level I ◽  
Trauma Surgeons

Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals’ and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.

Bicycle Helmets save More than Heads: Experience from a Pediatric Level I Trauma Hospital

2017 ◽  
Vol 83 (9) ◽  
pp. 1007-1011 ◽  
Author(s):  
Patrick D. Michael ◽  
Daniel L. Davenport ◽  
John M. Draus
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Demographic Data ◽  
Private Insurance ◽  
Hospital Costs ◽  
Study Cohort ◽  
Level I ◽  
Minor Injuries ◽  
Trauma Activation ◽  
Activation Criteria

We studied pediatric bicycle accident victims (age ≤ 15 years) who were treated at our pediatric Level I trauma center during a 10-year period. Demographic data, injury severity, hospital course, and hospital cost data were collected. We compared the children who were helmeted to those who were unhelmeted. Our study cohort consisted of 516 patients. Patients were mostly male (70.2%) and white (84.7%); the median age was nine years. There were 101 children in the helmet group and 415 children in the unhelmeted group. Helmeted children were more likely to have private insurance (68.3% vs 35.9%, P < 0.001). Unhelmeted children were more likely to sustain multiple injuries (40% vs 25.7%, P = 0.008), meet our trauma activation criteria (45.5% vs 16.8%, P < 0.001), and be admitted to the hospital (42.4% vs 14.9%, P < 0.001). Helmeted children were less likely to sustain brain injuries (15.8% vs 25.8%, P = 0.037), skull fractures (1% vs 10.8%, P = 0.001), and facial fractures (1% vs 6%, P = 0.040). Median hospital costs were more expensive in the unhelmeted group. Helmet usage was suboptimal. Although most children sustained relatively minor injuries, the unhelmeted children had more injuries and higher costs than those who used helmets. Injury prevention programs are warranted.

Common Denominators in Death from Pediatric Back-Over Trauma

2011 ◽  
Vol 77 (10) ◽  
pp. 1420-1422 ◽  
Author(s):  
Rebecca Stark ◽  
Steven Lee ◽  
Angela Neville ◽  
Brant Putnah ◽  
Scott Bricker
Keyword(s):  
Family Member ◽  
Head Trauma ◽  
Injury Severity ◽  
Pediatric Population ◽  
Female Gender ◽  
Blunt Head Trauma ◽  
Revised Trauma Score ◽  
Urban Level ◽  
Level I ◽  
Trauma Injury

Low-speed “back-over” injuries comprise a small number of pediatric automobile versus pedestrian (AVP) trauma, however these injuries tend to be more severe and have a higher rate of mortality. The objective of this study was to determine environmental, mechanistic, and demographic factors common in pediatric back-over injuries resulting in death. Patients were identified from the trauma registry of an urban Level I trauma center over a 15-year period. Charts for all pediatric AVP injuries in ages 4 years and younger were reviewed. Mortalities due to back-over injuries were identified. For the study period reviewed (1995–2010) we identified 535 cases of auto versus pedestrian injury in children less than 4-years-old. Of these, 31 (5.79%) were mortalities. Among those 31 mortalities, six (19.3%) were identified as resulting from back-over trauma. Mean age was significantly lower in back-over injuries as compared with non back-over AVP trauma (1.33 ± 0.23 years, vs 3.5 ± 1.0 years, P = 0.001). We noted a trend toward female gender (67%) and Hispanic ethnicity (67%). All sustained massive blunt head trauma as the cause of death. There were no significant differences in Injury Severity Score or Revised Trauma Score in the back-over group. Environmental analysis revealed that cars were the perpetrating vehicle 50 per cent of the time, and sport utility vehicles, vans, or trucks 50 per cent of the time. In all cases, the accidents occurred in the patient's own driveway and by either a family member (67%) or acquaintance (33%). These data suggest that key characteristics of back-over trauma resulting in mortality include very young age, massive head trauma, injury occurring in the patient's own driveway, and with a family member or acquaintance behind the wheel. This may help identify points of injury prevention to decrease the number of victims of back-over trauma in the pediatric population.

Mass Casualty Imaging—Policy, Planning, and Radiology Response to Mass Casualty Incidents

2020 ◽  
Vol 71 (3) ◽  
pp. 388-395
Author(s):  
Siobhán B. O’Neill ◽  
Brian Gibney ◽  
Michael E. O’Keeffe ◽  
Sarah Barrett ◽  
Luck Louis
Keyword(s):  
Health Care Providers ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Radiology Department ◽  
Policy Planning ◽  
Care Providers ◽  
Planning Stage ◽  
Large Numbers ◽  
Routine Procedures ◽  
Regional Hospitals

A mass casualty incident (MCI) is an event that generates more patients at one time than locally available resources can manage using routine procedures. By their nature, many of these incidents have no prior notice but result in large numbers of casualties with injuries that range in severity. They can happen anywhere and at any time and regional hospitals and health-care providers have to mount a response quickly and effectively to save as many lives as possible. Radiologists must go from passenger to pilot when it comes to MCI planning. When involved at the hospital-wide planning stage, they can offer valuable expertise on how radiology can improve triage accuracy and at what cost in terms of time and resources and thereby contribute a pragmatic understanding of radiology’s role and value during MCIs. By taking ownership of MCI planning in their own departments, radiologists can ensure that the radiology department can respond quickly and effectively to unforeseen emergencies. Well-designed radiology protocols will save lives in an MCI setting.

Reconsidering Policy of Casualty Evacuation in a Remote Mass-Casualty Incident

2013 ◽  
Vol 29 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Bruria Adini ◽  
Robert Cohen ◽  
Elon Glassberg ◽  
Bella Azaria ◽  
Daniel Simon ◽  
...  
Keyword(s):  
Injury Severity ◽  
Life Support ◽  
Tertiary Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Care Hospital ◽  
Publication Type ◽  
Local Hospital ◽  
Trauma Surgeons

AbstractObjectivesInappropriate distribution of casualties in mass-casualty incidents (MCIs) may overwhelm hospitals. This study aimed to review the consequences of evacuating casualties from a bus accident to a single peripheral hospital and lessons learned regarding policy of casualty evacuation.MethodsMedical records of all casualties relating to evacuation times, injury severity, diagnoses, treatments, resources utilized and outcomes were independently reviewed by two senior trauma surgeons. In addition, four senior trauma surgeons reviewed impact of treatment provided on patient outcomes. They reviewed the times for the primary and secondary evacuation, injury severity, diagnoses, surgical treatments, resources utilized, and the final outcomes of the patients at the point of discharge from the tertiary care hospital.ResultsThirty-one survivors were transferred to the closest local hospital; four died en route to hospital or within 30 minutes of arrival. Twenty-seven casualties were evacuated by air from the local hospital within 2.5 to 6.15 hours to Level I and II hospitals. Undertriage of 15% and overtriage of seven percent were noted. Four casualties did not receive treatment that might have improved their condition at the local hospital.ConclusionsIn MCIs occurring in remote areas, policy makers should consider revising the current evacuation plan so that only immediate unstable casualties should be transferred to the closest primary hospital. On site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.AdiniB, CohenR, GlassbergE, AzariaB, SimonD, SteinM, KleinY, PelegK. Reconsidering policy of casualty evacuation in a remote mass-casualty incident. Prehosp Disaster Med. 2013;28(6):1-5.

scholarly journals (P2-93) Triage During a Mass Casualty Incident: The 2009 Turkish Airlines Crash in Amsterdam

2011 ◽  
Vol 26 (S1) ◽  
pp. s166-s167 ◽  
Author(s):  
I.L.E. Postma ◽  
H. Weel ◽  
M. Heetveld ◽  
F. Bloemers ◽  
T. Bijlsma ◽  
...  
Keyword(s):  
Injury Severity ◽  
Spinal Injury ◽  
High Energy ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Emergency Intervention ◽  
Plane Crash ◽  
Spinal Immobilization ◽  
Prehospital Triage ◽  
Mechanism Of Trauma

IntroductionTriage is an important aspect of the management of mass-casualty incidents (MCIs). This study evaluates triage after the Turkish Airlines aircraft crash near Amsterdam in 2009. What were the results of triage? What were the injuries of priority 3, and of “walking” casualties? Did the mechanism of trauma have a factor in this mass-casualty triage? How does this affect spinal immobilization rate during transport?MethodsA retrospective analysis of investigational reports, ambulance forms, and medical charts of survivors of the crash was performed. Outcomes included triage classification, type of injury, Abbreviated Injury Scale (AIS) score, Injury Severity Scale (ISS) score, need for emergency intervention according to the “Baxt criteria”, and spinal immobilization during transport.ResultsThere was minimal documentation of prehospital triage. According to the in-hospital triage, 28% of patients were priority 1, 10% had an ISS score ≥ 16, and 3% met the Baxt criteria for emergency intervention. Forty percent were priority 3, 72% had an ISS score ≤ 8, and 63% were discharged from the emergency department. Approximately 83% were over-triaged, and the critical mortality rate was 0%. Nine percent of priority 3 casualties. and 17% of “walking” casualties had serious injuries. Twenty-five percent of all casualties were transported with spinal immobilization; 22% of patients with diagnosed spinal injury were not transported with spinal immobilization.ConclusionsAfter the Turkish Airlines crash, documentation of triage was minimal. According to the Baxt criteria, there was a great amount of over-triage. Possible injuries sustained by plane crash survivors that seem minimally harmed (P3) must not be underestimated. Considering spinal immobilization, Not insufficient consideration given the high-energy trauma mechanism.

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