(K115) Application of Patient Age-Dependent Sacco Triage Method to Victims with Blunt Injuries

Abstract

objective:

The Sacco Triage Method (STM) is a mathematical model of resource-constrained triage. The objective of this presentation is to apply STM-Age, an age-augmented version of STM, to blunt trauma victims and compare it to Simple Triage and Rapid Treatment (START) and START-like protocols.

Methods:

The objective of STM is to maximize the number of expected survivors given constraints on the timing and availability of resources. The STM incorporates estimates of time-dependent victim survival probabilities based on an initial assessment and expected deteriorations.

For the STM-Age application, an “RPM-Age” score (based on respiratory rate, pulse rate, best motor response, and coded age) was used to estimate survival probability. Logistic function-generated survival probability estimates for RPM-Age values were determined from 76,444 patients with blunt injuries from the Pennsylvania Trauma Outcome Study. The Delphi Method provided expert consensus on victim deterioration rates, and the model was solved using linear programming.

The STM-Age was compared to START and START-like methods with respect to process and to outcome, as measured by expected number of survivors, in simulated resource-constrained casualty incidents.

Results:

The RPM-Age was a more accurate predictor of survivability for blunt trauma than RPM, as measured by calibration and discrimination statistics. In simulations, STM-Age exhibited substantially more expected survivors than START and START-like protocols.

Conclusions:

Resource-constrained triage is modeled precisely as an evidence-based, outcome-driven method (STM-Age) that maximizes expected survivors in consideration of resources. The STM-Age offers life-saving and operational advantages over current methods.