Major incident triage: development and validation of a modified primary triage tool
| dc.contributor.advisor | Smith, Jason E | |
| dc.contributor.advisor | Wallis, Lee A | |
| dc.contributor.author | Vassallo, James M A | |
| dc.date.accessioned | 2019-02-04T11:37:23Z | |
| dc.date.available | 2019-02-04T11:37:23Z | |
| dc.date.issued | 2018 | |
| dc.date.updated | 2019-02-04T07:10:12Z | |
| dc.description.abstract | Introduction A key principle in the effective management of a major incident is triage, prioritising patients on the basis of their clinical acuity. However, existing methods of primary major incident triage demonstrate poor performance at identifying the Priority One patient in need of a life-saving intervention. The aim of this thesis was to derive an improved triage tool. Methods The first part of the thesis defined what constitutes a life-saving intervention. Then using a retrospective military cohort, the optimum physiological thresholds for identifying the need for life-saving intervention were determined; the combination of which was used to define the Modified Physiological Triage Tool (MPTT). The MPTT was validated using a large civilian trauma database and a prospective military cohort. Subsequently, to describe the safety profile of the MPTT, an analysis of the implications of under-triage was undertaken. Finally, pragmatic changes were made to the MPTT (MPTT-24) - in order to provide a more useable method of primary triage. Statistical analysis was conducted using sensitivities and specificities, with triage tool performance compared using a McNemar test. Results 32 interventions were considered life-saving and the optimum physiological thresholds to identify these were a GCS <14, 12 < RR <22 and a HR < 100. Within both the military and civilian populations, the MPTT outperformed all existing methods of triage with the greatest sensitivity and lowest rates of under-triage, but at the expense of over-triage. Applying pragmatic changes, the MPTT-24 had comparable performance to the MPTT and continued to outperform existing methods. Conclusion The priority of primary major incident triage is to identify patients in need of life-saving intervention and to minimise under-triage. Fulfilling these priorities, the MPTT-24 outperforms existing methods of triage and its use is recommended as an alternative to existing methods of primary major incident triage. The MPTT-24 also offers a theoretical reduction in time required to triage and uses a simplified conscious level assessment, thus allowing it to be used by less experienced providers. | |
| dc.identifier.apacitation | Vassallo, J. M. A. (2018). <i>Major incident triage: development and validation of a modified primary triage tool</i>. (). University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine. Retrieved from http://hdl.handle.net/11427/29232 | en_ZA |
| dc.identifier.chicagocitation | Vassallo, James M A. <i>"Major incident triage: development and validation of a modified primary triage tool."</i> ., University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine, 2018. http://hdl.handle.net/11427/29232 | en_ZA |
| dc.identifier.citation | Vassallo, J. 2018. Major incident triage: development and validation of a modified primary triage tool. University of Cape Town. | en_ZA |
| dc.identifier.ris | TY - Thesis / Dissertation AU - Vassallo, James M A AB - Introduction A key principle in the effective management of a major incident is triage, prioritising patients on the basis of their clinical acuity. However, existing methods of primary major incident triage demonstrate poor performance at identifying the Priority One patient in need of a life-saving intervention. The aim of this thesis was to derive an improved triage tool. Methods The first part of the thesis defined what constitutes a life-saving intervention. Then using a retrospective military cohort, the optimum physiological thresholds for identifying the need for life-saving intervention were determined; the combination of which was used to define the Modified Physiological Triage Tool (MPTT). The MPTT was validated using a large civilian trauma database and a prospective military cohort. Subsequently, to describe the safety profile of the MPTT, an analysis of the implications of under-triage was undertaken. Finally, pragmatic changes were made to the MPTT (MPTT-24) - in order to provide a more useable method of primary triage. Statistical analysis was conducted using sensitivities and specificities, with triage tool performance compared using a McNemar test. Results 32 interventions were considered life-saving and the optimum physiological thresholds to identify these were a GCS <14, 12 < RR <22 and a HR < 100. Within both the military and civilian populations, the MPTT outperformed all existing methods of triage with the greatest sensitivity and lowest rates of under-triage, but at the expense of over-triage. Applying pragmatic changes, the MPTT-24 had comparable performance to the MPTT and continued to outperform existing methods. Conclusion The priority of primary major incident triage is to identify patients in need of life-saving intervention and to minimise under-triage. Fulfilling these priorities, the MPTT-24 outperforms existing methods of triage and its use is recommended as an alternative to existing methods of primary major incident triage. The MPTT-24 also offers a theoretical reduction in time required to triage and uses a simplified conscious level assessment, thus allowing it to be used by less experienced providers. DA - 2018 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Major incident triage: development and validation of a modified primary triage tool TI - Major incident triage: development and validation of a modified primary triage tool UR - http://hdl.handle.net/11427/29232 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/29232 | |
| dc.identifier.vancouvercitation | Vassallo JMA. Major incident triage: development and validation of a modified primary triage tool. []. University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine, 2018 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/29232 | en_ZA |
| dc.language.iso | eng | |
| dc.publisher.department | Division of Emergency Medicine | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.publisher.institution | University of Cape Town | |
| dc.subject.other | Emergency Medicine | |
| dc.title | Major incident triage: development and validation of a modified primary triage tool | |
| dc.type | Doctoral Thesis | |
| dc.type.qualificationlevel | Doctoral | |
| dc.type.qualificationname | PhD |