Comparing the Accuracy of Mass Casualty Triage Systems When Used in an Adult Population

Courtney H. McKee, Robert W. Heffernan, Brian D. Willenbring, Richard B. Schwartz, J. Marc Liu, M. Riccardo Colella, E. Brooke Lerner

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: To use a previously published criterion standard to compare the accuracy of 4 different mass casualty triage systems (Sort, Assess, Lifesaving Interventions, Treatment/Transport [SALT], Simple Triage and Rapid Treatment [START], Triage Sieve, and CareFlight) when used in an emergency department-based adult population. Methods: We performed a prospective, observational study of a convenience sample of adults aged 18years or older presenting to a single tertiary care hospital emergency department. A co-investigator with prior emergency medical services (EMS) experience observed each subject’s initial triage in the emergency department and recorded all data points necessary to assign a triage category using each of the 4 mass casualty triage systems being studied. Subjects’ medical records were reviewed after their discharge from the hospital to assign the “correct” triage category using the criterion standard. The 4 mass casualty triage system assignments were then compared to the “correct” assignment. Descriptive statistics were used to compare accuracy and over- and under-triage rates for each triage system. Results: A total of 125 subjects were included in the study. Of those, 53% were male and 59% were transported by private vehicle. When compared to the criterion standard definitions, SALT was found to have the highest accuracy rate (52%; 95% CI 43–60) compared to START (36%; 95% CI 28–44), CareFlight (36%; 95% CI 28–44), and TriageSieve (37%; 95% CI 28–45). SALT also had the lowest under-triage rate (26%; 95% CI 19–34) compared to START (57%; 95% CI 48–66), CareFlight (58%; 95% CI 49–66), and TriageSieve (58%; 95% CI 49–66). SALT had the highest over-triage rate (22%; 95% CI 14–29) compared to START (7%; 95% CI 3–12), CareFlight (6%; 95% CI 2–11) and TriageSieve (6%; 95% CI 2–11). Conclusion: We found that SALT triage most often correctly triaged adult emergency department patients when compared to a previously published criterion standard. While there are no target under- and over-triage rates that have been published for mass casualty triage, all 4 systems had relatively high rates of under-triage.

Original languageEnglish (US)
Pages (from-to)515-524
Number of pages10
JournalPrehospital Emergency Care
Issue number4
StatePublished - Jul 3 2020


  • CareFlight
  • SALT
  • Triage Sieve
  • accuracy
  • disaster
  • mass casualty triage

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency


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