Department of Anesthesiology and Operative Intensive Care Medicine, Faculty of Medicine, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
Interdisciplinary Emergency Department, Medical Faculty, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany.
Anaesthesiologie. 2023 Dec;72(Suppl 1):1-9. doi: 10.1007/s00101-023-01292-2. Epub 2023 Oct 12.
In the event of a mass casualty incident (MCI), the situation-related shortage of medical resources does not end when the patients are transported from the scene of the incident. Consequently, an initial triage is required in the receiving hospitals. In the first step, the aim of this study was to create a reference patient vignette set with defined triage categories. This allowed a computer-aided evaluation of the diagnostic quality of triage algorithms for MCI situations in the second step.
A total of 250 case vignettes validated in practice were entered into a multistage evaluation process by initially 6 and later 36 triage experts. This algorithm-independent expert evaluation of all vignettes-served as the gold standard for analyzing the diagnostic quality of the following triage algorithms: Manchester triage system (MTS module MCI), emergency severity index (ESI), Berlin triage algorithm (BER), the prehospital algorithms PRIOR and mSTaRT, and two project algorithms from a cooperation between the Federal Office of Civil Protection and Disaster Assistance (BBK) and the Hashemite Kingdom of Jordan-intrahospital Jordanian-German project algorithm (JorD) and prehospital triage algorithm (PETRA). Each patient vignette underwent computerized triage through all specified algorithms to obtain comparative test quality outcomes.
Of the original 250 vignettes, a triage reference database of 210 patient vignettes was validated independently of the algorithms. These formed the gold standard for comparison of the triage algorithms analyzed. Sensitivities for intrahospital detection of patients in triage category T1 ranged from 1.0 (BER, JorD, PRIOR) to 0.57 (MCI module MTS). Specificities ranged from 0.99 (MTS and PETRA) to 0.67 (PRIOR). Considering Youden's index, BER (0.89) and JorD (0.88) had the best overall performance for detecting patients in triage category T1. Overtriage was most likely with PRIOR, and undertriage with the MCI module of MTS. Up to a decision for category T1, the algorithms require the following numbers of steps given as the median and interquartile range (IQR): ESI 1 (1-2), JorD 1 (1-4), PRIOR 3 (2-4), BER 3 (2-6), mSTaRT 3 (3-5), MTS 4 (4-5) and PETRA 6 (6-8). For the T2 and T3 categories the number of steps until a decision and the test quality of the algorithms are positively interrelated.
In the present study, transferability of preclinical algorithm-based primary triage results to clinical algorithm-based secondary triage results was demonstrated. The highest diagnostic quality for secondary triage was provided by the Berlin triage algorithm, followed by the Jordanian-German project algorithm for hospitals, which, however, also require the most algorithm steps until a decision.
在发生大规模伤亡事件（MCI）时，从事件现场运送患者后，与情况相关的医疗资源短缺并不会结束。因此，在接收医院需要进行初步分诊。在第一步中，本研究的目的是创建一个具有明确定义分诊类别的参考患者病例集。这使得在第二步中可以使用计算机辅助评估 MCI 情况下的分诊算法的诊断质量。
总共 250 个在实践中验证的病例被输入到一个多阶段评估过程中，最初有 6 名，后来有 36 名分诊专家。所有病例的这种独立于算法的专家评估——作为分析以下分诊算法的诊断质量的金标准：曼彻斯特分诊系统（MTS 模块 MCI）、紧急严重程度指数（ESI）、柏林分诊算法（BER）、院前算法 PRIOR 和 mSTaRT，以及联邦民防和灾害援助办公室（BBK）与约旦哈希姆王国之间合作的两个项目算法——院内约旦-德国项目算法（JorD）和院前分诊算法（PETRA）。每个患者病例都通过所有指定的算法进行了计算机分诊，以获得比较测试质量结果。
最初的 250 个病例中，有 210 个病例的分诊参考数据库独立于算法进行了验证。这些构成了分析的分诊算法比较的金标准。在分诊类别 T1 中检测到院内患者的敏感性从 1.0（BER、JorD、PRIOR）到 0.57（MCI 模块 MTS）不等。特异性从 0.99（MTS 和 PETRA）到 0.67（PRIOR）不等。考虑尤登指数，BER（0.89）和 JorD（0.88）在检测分诊类别 T1 中的患者方面表现出最佳的整体性能。PRIOR 最有可能过度分诊，MTS 的 MCI 模块最有可能分诊不足。在做出 T1 类别的决定之前，这些算法需要以下中位数和四分位距（IQR）的步骤数：ESI 1（1-2）、JorD 1（1-4）、PRIOR 3（2-4）、BER 3（2-6）、mSTaRT 3（3-5）、MTS 4（4-5）和 PETRA 6（6-8）。对于 T2 和 T3 类别，直到做出决定的步骤数和算法的测试质量呈正相关。
在本研究中，证明了基于临床算法的二次分诊中，临床前基于算法的初步分诊结果的可转移性。柏林分诊算法提供了最高的二次分诊诊断质量，其次是院内约旦-德国项目算法，但做出决定所需的算法步骤最多。
