Author: Amy Hughes / Codes: / Published: 15/05/2019
- Amy Hughes
- Susie Roy
What this paper adds
Provides a great overview of the presentation of Measles in the Emergency Department in addition to highlighting approaches to diagnoses (which may be challenging), diagnoses and management. The paper also provides a comprehensive oversight to vaccination relevant to Measles.
Could this be Measles?
ODonnell S, Davies F, Vardhan M, et al; Could this be measles? Emerg Med J 2019;36:310-314.
Case based discussion and review
RCEM curriculum coverage
CAP 28: Rash
HAP 14: Fever
HAP 28: Rash life threatening rashes
- Andrew Tabner
- Graham Johnson
What is already known on this subject
The key to success in major incident triage is identifying patients in need of life-saving interventions (LSIs). Currently, the UK and many other countries use a two-stage approach to major incident triage.
As a secondary triage process, the Triage Sort aims to refine the triage decisions previously made by primary triage tools. It has previously demonstrated good success at predicting mortality from injury.
However, in studies in the military environment, the Triage Sort has shown limited ability to predict the need for LSI.
What this study adds
Applying the Triage Sort retrospectively to a civilian trauma database (UK TARN), this study has demonstrated that the Triage Sort has poor sensitivity in identifying patients in need of LSI, and had lower sensitivity than two primary triage methods, the National Ambulance Resilience Unit (NARU) Sieve and the Modified Physiological Triage Tool-24 (MPTT-24).
Major incident triage and the evaluation of the Triage Sort as a secondary triage method
James Vassallo, Jason Smith
Emerg Med J,2019;36:281286.
Retrospective database review.
What was assessed?
The sensitivity and specificity of Triage Sort, NARU and MPTT-24 for predicting the need for Life-saving Interventions (LSI) in trauma patients
- 127,233 patients included (nearly 50% excluded due to missing data)
- Triage Sort sensitivity 15.7%, specificity 98.6% for LSI
- NARU sensitivity 29.5%, specificity 93.6%
- MPTT-24 sensitivity 53.5%, highest rate of over-triage
Within a civilian trauma registry population, the Triage Sort demonstrated the poorest performance at identifying patients in need of LSI. Its use as a secondary triage tool should be reviewed, with an urgent need for further research to determine the optimum method of secondary triage.
Limitations (includes authors and our own)
- Database study rather than real world analysis
- TARN database includes all trauma modalities, not specifically major incident situations
- Some patients excluded by TARN (e.g. low ISS) may well lead to over-estimation of specificity
- Deaths on scene and those not conveyed to hospital for any reason were excluded due to TARN characteristics
Existing methods of major incident triage are flawed; Triage Sort has poor sensitivity for the need for LSI and is out-performed in this study cohort by other tools. Triage Sort is still in use, but will likely be replaced by an alternative in the future.
RCEM curriculum coverage
HAP 20: Major Incident management
Major Incident Management Jamie Sillett
Major incident archives St. Emlyns
- Getting started in research Part 1 Graham Johnson and Andrew Tabner
- Getting started in research Part 2 Graham Johnson and Andrew Tabner
- Major Incidents Part 1 Jonathon Hurley
- Major Incidents 2: Incident Plans Jonathon Hurley
- Delphi Study
Vassallo J, Smith JE, Bruijns SR, Wallis LA.
Injury. 2016 Sep;47(9):1898-902.
- Derivation Study of the MPTT
Vassallo J, Beavis J, Smith JE, Wallis LA.
Injury. 2017 May;48(5):992-999.
- MPTT-24 Article
Vassallo J, Smith JE, Wallis LA.
J R Army Med Corps. 2018 May;164(2):103-106.
- Original study that started it all off!
Horne S, Vassallo J, Read J, Ball S.
Injury. 2013 Jan;44(1):23-8.
SPSS Resources (both require purchasing)
- Andy Field: Discovering statistics Using IBM statistics
- Laerd Statistics guides available here.