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

  • Nicholas McGlynn (a1), Ilene Claudius (a2) (a3) (a4), Amy H. Kaji (a2) (a3) (a4), Emilia H. Fisher (a5), Alaa Shaban (a6), Mark X. Cicero (a7), Genevieve Santillanes (a1) (a8), Marianne Gausche-Hill (a2) (a3) (a4) (a9), Todd P. Chang (a1) (a10) and J. Joelle Donofrio-Odmann (a11) (a12)...

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.

Copyright

Corresponding author

Correspondence: Ilene Claudius, MD, Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaUSA, E-mail: iaclaudius@gmail.com

References

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1.Lerner, EB, Schwartz, RB, Coule, PL, et al.Mass casualty triage: an evaluation of the data and development of a proposed national guideline. Disaster Med Pubic Health Prep. 2018;2(Suppl 1):S2534.
2.Lerner, EB, Cone, DC, Weinstein, ES, et al.Mass casualty triage: an evaluation of the science and refinement of a national guideline. Disaster Med Public Health Prep. 2011;5(2):129137.
3.Heffernan, RW, Lerner, EB, McKee, CH, et al.Comparing the accuracy of mass casualty triage systems in a pediatric population. Prehosp Emerg Care. 2019;23(3):304308.
4.Jones, N, White, ML, Tofil, N, et al.Randomized trial comparing two mass casualty triage systems (JumpSTART versus SALT) in a pediatric simulated mass casualty event. Prehosp Emerg Care. 2014;18(3):417423.
5.Lerner, EB, Schwartz, RB, Coule, PL, Pirrallo, RG. Use of SALT triage in a simulated mass-casualty incident. Prehosp Emerg Care. 2010;14(1):2125.
6.Silvestri, S, Field, A, Mangalat, N, et al.Comparison of START and SALT triage methodologies to reference standard definitions and to a field mass casualty simulation. Am J Disaster Med. 2017;12(1):2733.
7.Dubrowski, A. Simulation as a suitable education approach for medical training in marine and off-shore industries: theoretical underpinning. Int Marit Health. 2015;66(3):164167.
8.Ke, Y-T, Chen, H-C, Lin, C-H, et al.Posttraumatic psychiatric disorders and resilience in health care providers following a disastrous earthquake: an interventional study in Taiwan. BioMed Research International. 2017;2981624.

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Supplementary materials

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

  • Nicholas McGlynn (a1), Ilene Claudius (a2) (a3) (a4), Amy H. Kaji (a2) (a3) (a4), Emilia H. Fisher (a5), Alaa Shaban (a6), Mark X. Cicero (a7), Genevieve Santillanes (a1) (a8), Marianne Gausche-Hill (a2) (a3) (a4) (a9), Todd P. Chang (a1) (a10) and J. Joelle Donofrio-Odmann (a11) (a12)...

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