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Tabletop Application of SALT Triage to 10, 100, and 1000 Pediatric Victims

Published online by Cambridge University Press:  14 February 2020

Nicholas McGlynn
Affiliation:
Keck School of Medicine of University of Southern California, Los Angeles, CaliforniaUSA
Ilene Claudius*
Affiliation:
Harbor-UCLA Medical Center, Torrance, CaliforniaUSA David Geffen School of Medicine, Los Angeles, CaliforniaUSA Lundquist at Harbor-UCLA, Torrance, CaliforniaUSA
Amy H. Kaji
Affiliation:
Harbor-UCLA Medical Center, Torrance, CaliforniaUSA David Geffen School of Medicine, Los Angeles, CaliforniaUSA Lundquist at Harbor-UCLA, Torrance, CaliforniaUSA
Emilia H. Fisher
Affiliation:
Children’s Hospitals and Clinics of Minnesota, St. Paul, MinnesotaUSA
Alaa Shaban
Affiliation:
Community Health Centers, Santa Maria, CaliforniaUSA
Mark X. Cicero
Affiliation:
Yale University School of Medicine, New Haven, Connecticut, USA
Genevieve Santillanes
Affiliation:
Keck School of Medicine of University of Southern California, Los Angeles, CaliforniaUSA Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CaliforniaUSA
Marianne Gausche-Hill
Affiliation:
Harbor-UCLA Medical Center, Torrance, CaliforniaUSA David Geffen School of Medicine, Los Angeles, CaliforniaUSA Lundquist at Harbor-UCLA, Torrance, CaliforniaUSA Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CaliforniaUSA
Todd P. Chang
Affiliation:
Keck School of Medicine of University of Southern California, Los Angeles, CaliforniaUSA Children’s Hospital Los Angeles, Los Angeles, CaliforniaUSA
J. Joelle Donofrio-Odmann
Affiliation:
University of California San Diego, Departments of Pediatrics and Emergency Medicine, San Diego, CaliforniaUSA Rady Children’s Hospital of San Diego, San Diego, CaliforniaUSA
*
Correspondence: Ilene Claudius, MD, Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaUSA, E-mail: iaclaudius@gmail.com

Abstract

Introduction:

The Sort, Access, Life-saving interventions, Treatment and/or Triage (SALT) mass-casualty incident (MCI) algorithm is unique in that it includes two subjective questions during the triage process: “Is the victim likely to survive given the resources?” and “Is the injury minor?”

Hypothesis/Problem:

Given this subjectivity, it was hypothesized that as casualties increase, the inter-rater reliability (IRR) of the tool would decline, due to an increase in the number of patients triaged as Minor and Expectant.

Methods:

A pre-collected dataset of pediatric trauma patients age <14 years from a single Level 1 trauma center was used to generate “patients.” Three trained raters triaged each patient using SALT as if they were in each of the following scenarios: 10, 100, and 1,000 victim MCIs. Cohen’s kappa test was used to evaluate IRR between the raters in each of the scenarios.

Results:

A total of 247 patients were available for triage. The kappas were consistently “poor” to “fair:” 0.37 to 0.59 in the 10-victim scenario; 0.13 to 0.36 in the 100-victim scenario; and 0.05 to 0.36 in the 1,000-victim scenario. There was an increasing percentage of subjects triaged Minor as the number of estimated victims increased: 27.8% increase from 10- to 100-victim scenario and 7.0% increase from 100- to 1,000-victim scenario. Expectant triage categorization of patients remained stable as victim numbers increased.

Conclusion:

Overall, SALT demonstrated poor IRR in this study of increasing casualty counts while triaging pediatric patients. Increased casualty counts in the scenarios did lead to increased Minor but not Expectant categorizations.

Type
Original Research
Copyright
© World Association for Disaster and Emergency Medicine 2020

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References

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Supplementary material: File

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Appendix 1

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