Cicero Mark X, Overly Frank, Brown Linda, Yarzebski Jorge, Walsh Barbara, Shabanova Veronika, Auerbach Marc, Riera Antonio, Adelgais Kathleen, Meckler Garth, Cone David C, Baum Carl R
1Department of Emergency Medicine,Yale School of Medicine,New Haven,Connecticut.
2Department of Emergency Medicine,Warren Alpert School of Medicine of Brown University,Providence,Rhode Island.
Disaster Med Public Health Prep. 2016 Apr;10(2):253-60. doi: 10.1017/dmp.2015.171. Epub 2016 Jan 8.
It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes.
We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients' expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased).
There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (P<0.001; OR [odds ratio]: 2.03; interquartile range [IQR]: 1.30, 3.17) or CDM (P=0.02; OR: 1.76; IQR: 1.10, 2.82). JumpSTART outperformed Smart for RED patients (P=0.05; OR: 1.48; IQR: 1.01,2.17), and outperformed both Smart (P<0.001; OR: 3.22; IQR: 1.78,5.88) and CDM (P<0.001; OR: 2.86; IQR: 1.53,5.26) for YELLOW patients. Furthermore, JumpSTART outperformed CDM for BLACK patients (P=0.01; OR: 5.55; IQR: 1.47, 20.0).
Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM.
目前尚不清楚哪种儿科灾难分诊（PDT）策略能产生最佳准确性或最佳患者结局。
我们对一项前瞻性队列研究中的紧急医疗服务提供者样本进行了横断面分析，比较了两种PDT策略（Smart和JumpSTART）以及无算法的临床决策（CDM）的准确性和分诊结果。参与者按分诊策略分为不同队列。我们展示了10名受害者的多模式灾难模拟。采用德尔菲法确定患者的预期分诊级别。我们比较了总体分诊准确性以及每个分诊级别（红色/立即处理、黄色/延迟处理、绿色/可步行、黑色/死亡）的准确性。
共有273名参与者（71名采用JumpSTART，122名采用Smart，81名采用CDM）。Smart分诊与CDM之间无显著差异。使用JumpSTART分诊时，其准确性高于Smart（P<0.001；优势比[OR]：2.03；四分位间距[IQR]：1.30，3.17）或CDM（P=0.02；OR：1.76；IQR：1.10，2.82）。对于红色患者，JumpSTART的表现优于Smart（P=0.05；OR：1.48；IQR：1.01，2.17）；对于黄色患者，JumpSTART的表现优于Smart（P<0.001；OR：3.22；IQR：1.78，5.88）和CDM（P<0.001；OR：2.86；IQR：1.53，5.26）。此外，对于黑色患者，JumpSTART的表现优于CDM（P=0.01；OR：5.55；IQR：1.47，20.0）。
我们基于模拟的比较表明，JumpSTART分诊优于Smart和CDM。对于红色患者，JumpSTART的表现优于Smart；对于黑色患者，JumpSTART的表现优于CDM。对于黄色患者，JumpSTART产生的分诊结果比Smart分诊或CDM更准确。
