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Introduction
Resources to assist in a surge of critically ill or injured individuals during a disaster or mass-causality incident (MCI) may be limited, creating a discrepancy between needs and available resources. 1 Unlike triage within the hospital, disaster triage must perform the delicate task of balancing the need of each patient for medical care and the overarching needs of the health care system to avoid overwhelming health care capacity. This can be an unusual and frightening event for health care providers who often respond to disasters working in unfamiliar conditions and are forced to make uncomfortable, morally challenging, and critical clinical care decisions with minimal information.
To address these concerns, numerous disaster triage algorithms have been developed. Their goals are to provide an easily learnable and consistent tool to aid in these difficult decisions. Many are based on simple flow charts with the goal of facilitating difficult clinical decisions during times of provider stress while ensuring that victims of a disaster or MCI are prioritized based on their clinical needs. The ability of these disaster triage tools to accurately triage victims is important. Under-triage (poor sensitivity) can result in a failure to recognize victims who could benefit from urgent medical intervention. Conversely, over-triage (poor specificity) results in valuable resources being used prematurely or unnecessarily.
To assist in the triage of victims of a disaster or MCI, the Simple Triage and Rapid Treatment (START) tool was introduced in 1983 by the Newport Beach Fire and Marine Department (Newport Beach, California USA) and the Hoag Hospital (Orange County, California USA) using the now familiar groups of black (expectant), red (immediate), yellow (delayed), and green (minor) to prioritize care of disaster victims. 2 As the tool is based on a simple flowchart, it has been targeted to providers of all groups (ie, physicians, nurses, trainees, and prehospital providers) as a simple way to promote consistent and reproducible triage.
Despite being one of the most commonly used and studied disaster triage systems world-wide, there are no published syntheses on the accuracy of the START tool. The purpose of this meta-analysis was to assess overall accuracy, as well as the proportion of under- and over-triage, for the START method when used by providers across a variety of backgrounds. In addition,...