ArticleScandinavian journal of trauma, resuscitation and emergency medicine2017
Impact of systolic blood pressure limits on the diagnostic value of triage algorithms.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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10 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- A translational triage research development tool: standardizing prehospital triage decision-making systems in mass casualty incidents.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Pooled it
- Article
- Validation of secondary triage algorithms for mass casualty incidents : A simulation-based study-English version.Die Anaesthesiologie · 2023Article
- Covid-19 triage in the emergency department 2.0: how analytics and AI transform a human-made algorithm for the prediction of clinical pathways.Health care management science · 2023Article
- [Validation of secondary triage algorithms for mass casualty incidents-A simulation-based study-German version].Die Anaesthesiologie · 2023Article
- Factors Associated with Cardiac/Pericardial Injury among Blunt Injury Patients: A Nationwide Study in Japan.Journal of clinical medicine · 2022Article
- Developing a translational triage research tool: part two-evaluating the tool through a Delphi study among experts.Scandinavian journal of trauma, resuscitation and emergency medicine · 2022Article
- Assessing the impact of the national traffic safety campaign: a nationwide cohort study in Japan.BMJ open · 2022Article
- Trends and outcomes of blunt renal trauma management: a nationwide cohort study in Japan.World journal of emergency surgery : WJES · 2020Article
- Relationship between in-hospital mortality and abdominal angiography among patients with blunt liver injuries: a propensity score-matching from a nationwide trauma registry of Japan.Acute medicine & surgeryArticle
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Authors and funding
3 authors at 1 institution in 1 country.
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Abstract
backgroundMajor incidents are characterized by a lack of resources compared to an overwhelming number of casualties, requiring a prioritization of medical treatment. Triage algorithms are an essential tool for prioritizing the urgency of treatment for patients, but the evidence to support one over another is very limited. We determined the influence of blood pressure limits on the diagnostic value of triage algorithms, considering if pulse should be palpated centrally or peripherally.
methodsWe used a database representing 500 consecutive HEMS patients. Each patient was allocated a triage category (T1/red, T2/yellow, T3/green) by a group of experienced doctors in disaster medicine, independent of any algorithm. mSTaRT, ASAV, Field Triage Score (FTS), Care Flight (CF), "Model Bavaria" and two Norwegian algorithms (Nor and TAS), all containing the question "Pulse palpable?", were translated into Excel commands, calculating the triage category for each patient automatically. We used 5 blood pressure limits ranging from 130 to 60 mmHg to determine palpable pulse. The resulting triage categories were analyzed with respect to sensitivity, specificity and Youden Index (J) separately for trauma and non-trauma patients, and for all patients combined.
resultsFor the entire population of patients within all triage algorithms the Youden Index (J) was highest for T1 (J between 0,14 and 0,62). Combining trauma and non-trauma patients, the highest J was obtained by ASAV (J = 0,62 at 60 mmHg). ASAV scored the highest within trauma patients (J = 0,87 at 60 mmHg), whereas Model Bavaria (J = 0,54 at 80 mmHg) reached highest amongst non-trauma patients. FTS performed worst for all patients (J = 0,14 at 60 mmHg), showing a lower score for trauma patients (J = 0,0 at 60 mmHg). Change of blood pressure limits resulted in different diagnostic values of all algorithms. DISCUSSION: We demonstrate that differing blood pressure limits have a remarkable impact on diagnostic values of triage algorithms. Further research is needed to determine the lowest blood pressure value that is possible to palpate at a peripheral artery compared to a central artery.
conclusionAs a consequence, it might be important in which location pulses are palpated according to the algorithm at hand during triage of patients.
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