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Heller AR, Neidel T, Klotz PJ, Solarek A, Kowalzik B, Juncken K, Kleber C. Validation of secondary triage algorithms for mass casualty incidents : A simulation-based study-English version. Anaesthesiologie 2023; 72:1-9. [PMID: 37823925 PMCID: PMC10692258 DOI: 10.1007/s00101-023-01292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Axel R Heller
- Department of Anesthesiology and Operative Intensive Care Medicine, Faculty of Medicine, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - Tobias Neidel
- 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
| | - Patrick J Klotz
- Department of Anesthesiology and Operative Intensive Care Medicine, Faculty of Medicine, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - André Solarek
- Department of Disaster preparedness and Emergency Planning, Charité, Berlin, Germany
| | - Barbara Kowalzik
- Division III.3 Protection of Health, German Federal Office for Civil Protection and Disaster Assistance, Bonn, Germany
| | - Kathleen Juncken
- Medical Directorate, Dresden Municipal Hospital, Dresden, Germany
| | - Christan Kleber
- Clinic and Polyclinic for Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig AöR, Leipzig, Germany
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Heller AR, Neidel T, Klotz PJ, Solarek A, Kowalzik B, Juncken K, Kleber C. [Validation of secondary triage algorithms for mass casualty incidents-A simulation-based study-German version]. Anaesthesiologie 2023:10.1007/s00101-023-01291-3. [PMID: 37318526 DOI: 10.1007/s00101-023-01291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Axel R Heller
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - Tobias Neidel
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
- Interdisziplinäre Notaufnahme, Medizinische Fakultät, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Patrick J Klotz
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - André Solarek
- Stabsstelle Katastrophenschutz, Charité, Berlin, Deutschland
| | - Barbara Kowalzik
- Referat III.3 Schutz der Gesundheit, Bundesamt für Bevölkerungsschutz und Katastrophenhilfe, Bonn, Deutschland
| | - Kathleen Juncken
- Medizinisches Direktorium, Städtisches Klinikum Dresden, Dresden, Deutschland
| | - Christan Kleber
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie (OUP), Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
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Lünsmann BJ, Polotzek K, Kleber C, Gebler R, Bierbaum V, Walther F, Baum F, Juncken K, Forkert C, Lange T, Held HC, Mogwitz A, Weidemann RR, Sedlmayr M, Lakowa N, Stehr SN, Albrecht M, Karschau J, Schmitt J. Regional responsibility and coordination of appropriate inpatient care capacities for patients with COVID-19 - the German DISPENSE model. PLoS One 2022; 17:e0262491. [PMID: 35085297 PMCID: PMC8794159 DOI: 10.1371/journal.pone.0262491] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/27/2021] [Indexed: 01/15/2023] Open
Abstract
As of late 2019, the COVID-19 pandemic has been a challenge to health care systems worldwide. Rapidly rising local COVID-19 incidence rates, result in demand for high hospital and intensive care bed capacities on short notice. A detailed up-to-date regional surveillance of the dynamics of the pandemic, precise prediction of required inpatient capacities of care as well as a centralized coordination of the distribution of regional patient fluxes is needed to ensure optimal patient care. In March 2020, the German federal state of Saxony established three COVID-19 coordination centers located at each of its maximum care hospitals, namely the University Hospitals Dresden and Leipzig and the hospital Chemnitz. Each center has coordinated inpatient care facilities for the three regions East, Northwest and Southwest Saxony with 36, 18 and 29 hospital sites, respectively. Fed by daily data flows from local public health authorities capturing the dynamics of the pandemic as well as daily reports on regional inpatient care capacities, we established the information and prognosis tool DISPENSE. It provides a regional overview of the current pandemic situation combined with daily prognoses for up to seven days as well as outlooks for up to 14 days of bed requirements. The prognosis precision varies from 21% and 38% to 12% and 15% relative errors in normal ward and ICU bed demand, respectively, depending on the considered time period. The deployment of DISPENSE has had a major positive impact to stay alert for the second wave of the COVID-19 pandemic and to allocate resources as needed. The application of a mathematical model to forecast required bed capacities enabled concerted actions for patient allocation and strategic planning. The ad-hoc implementation of these tools substantiates the need of a detailed data basis that enables appropriate responses, both on regional scales in terms of clinic resource planning and on larger scales concerning political reactions to pandemic situations.
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Affiliation(s)
- Benedict J. Lünsmann
- Center for Evidence-based Healthcare, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- * E-mail:
| | - Katja Polotzek
- Center for Evidence-based Healthcare, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Christian Kleber
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Richard Gebler
- Institute for Medical Informatics and Biometry, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Veronika Bierbaum
- Center for Evidence-based Healthcare, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Felix Walther
- Center for Evidence-based Healthcare, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Fabian Baum
- Center for Evidence-based Healthcare, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Kathleen Juncken
- Clinic for Infectious Diseases and Tropical Medicine, Klinikum Chemnitz, Chemnitz, Germany
| | - Christoph Forkert
- Center for Evidence-based Healthcare, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Toni Lange
- Center for Evidence-based Healthcare, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Hanns-Christoph Held
- Department of Anesthesia and Critical Care Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Andreas Mogwitz
- University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | | | - Martin Sedlmayr
- Institute for Medical Informatics and Biometry, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Nicole Lakowa
- Clinic for Infectious Diseases and Tropical Medicine, Klinikum Chemnitz, Chemnitz, Germany
| | - Sebastian N. Stehr
- Department of Anesthesia and Critical Care Medicine, Leipzig University Hospital, Leipzig, Germany
| | | | - Jens Karschau
- Center for Evidence-based Healthcare, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital Dresden and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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