Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.
Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.
PLoS One. 2020 Jun 5;15(6):e0234156. doi: 10.1371/journal.pone.0234156. eCollection 2020.
Mis-triage may have serious consequences for patients in mass casualty incidents (MCI) at sea. The purpose of this study was to assess outcome, reliability and validity of an analogue and a digital recording system for triage of a MCI at sea.
The study based on a triage exercise conducted with a cross-over-design. Forty-eight volunteers were presented a fictional MCI with 50 cases. The volunteers were randomly assigned to start with the analogue (Group A, starting with the analogue followed by the digital system) or digital system (Group B, starting with the digital followed by the analogue system). Triage score distribution and agreement between the triage methods and a predefined standard were reported. Reliability was analysed using Cronbach's Alpha and Cohen's Kappa. Validity was measured through sensitivity, specificity and predictive value. Treatment, period and carry-over-effects were analysed using a linear mixed-effects model.
The number of patients triaged (total: n = 3545) with the analogue system (n = 1914; 79.75%) was significantly higher (p = 0.001) than with the digital system (n = 1631; 67.96%). A trend towards a higher percentage of correct triages with the digital system was observed (p = 0.282). Ratio of under-triage was significantly smaller with the digital system (p = 0.001). Validity measured with Cronbach's Alpha and Cohen's Kappa was higher with the digital system. So was sensitivity (category; green: 80.67%, yellow: 73.24%, red: 83.54%; analogue: green: 93.28%, yellow: 82.36%, red: 94.04%) and specificity of the digital system (green: 78.07%, yellow: 63.75%, red: 66.25%; analogue: green: 85.50%, yellow: 79.88%, red: 91.50%). Comparing the predictive values and accuracy, the digital system showed higher scores than the analogue system. No significant patterns of carry-over-effects were observed.
Significant differences were found for the number of triages comparing the analogue and digital recording system. The digital system has a slightly higher reliability and validity than the analogue triage system.
分诊错误可能对海上重大伤亡事件（MCI）中的患者产生严重后果。本研究旨在评估一种模拟和数字记录系统在海上 MCI 分诊中的结果、可靠性和有效性。
该研究基于一项交叉设计的分诊演习。48 名志愿者参与了一项虚构的 MCI，共有 50 例病例。志愿者被随机分配使用模拟系统（A 组，先使用模拟系统，然后使用数字系统）或数字系统（B 组，先使用数字系统，然后使用模拟系统）。报告了分诊方法的分诊评分分布和与预设标准的一致性。使用 Cronbach 的 Alpha 和 Cohen 的 Kappa 分析可靠性。通过灵敏度、特异性和预测值来衡量有效性。使用线性混合效应模型分析治疗、时期和延续效应。
使用模拟系统分诊的患者数量（总数：n = 3545）明显高于使用数字系统（n = 1631；79.75%）（p = 0.001）。观察到使用数字系统时正确分诊的百分比呈上升趋势（p = 0.282）。使用数字系统时，分诊不足的比例明显较小（p = 0.001）。使用数字系统测量的有效性（Cronbach 的 Alpha 和 Cohen 的 Kappa）更高。数字系统的灵敏度（类别；绿色：80.67%，黄色：73.24%，红色：83.54%；模拟系统：绿色：93.28%，黄色：82.36%，红色：94.04%）和特异性也更高（绿色：78.07%，黄色：63.75%，红色：66.25%；模拟系统：绿色：85.50%，黄色：79.88%，红色：91.50%）。比较预测值和准确率，数字系统的得分高于模拟系统。未观察到明显的延续效应模式。
模拟和数字记录系统的分诊数量存在显著差异。数字系统的可靠性和有效性略高于模拟分诊系统。
