Accuracy of the Simple Triage and Rapid Treatment (START) algorithm in accident and disaster triage: an integrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v11i15.37234

Keywords:

Mass Casualty Incidents; Protocol; Triage.

Abstract

The Simple Triage and Rapid Treatment (START) algorithm was proposed to identify salvageable victims from those with imminent mortality, and is the most popular triage system worldwide. Therefore, demonstrating the accuracy of the START protocol is of fundamental importance, since it operates in an extreme scenario and time and effective decision making can save lives. Thus, this study aims to analyze the accuracy of the START algorithm in triage of accidents and disasters. This is an integrative literature review, and the following databases were used for the research: PUBMED, LILACS, and COCHRANE. The screening process had the following inclusion criteria: articles that answered the guiding question, in English or Portuguese, and between 2017 and 2021. After the searches, a total of 7 articles were obtained for review. Victim management using the START protocol allows the rescuer to quickly decide the expected level of care needed in order to focus advanced pre-hospital care on patients requiring immediate interventions. This algorithm could significantly hasten the triage process and reduce under-triage over time, even when adopted by non-medical personnel, especially when establishing triage points. Correct triage was demonstrated in 36% of patients, with under-screening occurring in 56.8% of patients. Overall, the START protocol meets the needs of mass casualty care, but it needs modifications to become a more effective protocol. Thus, it is necessary to continue with new studies on the accuracy and ways to optimize this protocol in order to optimize the triage system, promoting quick and effective decision making.

References

ACS. (2018). American College of Surgions Committee on Trauma. Advance Trauma Life Suport – ATLS. (10a ed.).

Campos, A. L. (2015). Atendimento de emergência realizado por profissionais de enfermagem, médico, bombeiros e demais profissionais treinados a vítimas de acidentes e catástrofes. Revista de Medicina e Saúde de Brasília, 4(1).

Costa, P. A. (2018). Método START: Aplicabilidade no atendimento pré-hospitalar em incidentes com múltiplas vítimas. Trabalho de Conclusão de Curso (Graduação em Enfermagem) – Faculdade de Sinop, Sinop – MT.

Cross, K. P., & Cicero, M. X. (2013). Head-to-head comparison of disaster triage methods in pediatric, adult, and geriatric patients. Annals of emergency medicine, 61(6), 668-676.

Curran-Sills, G., & Franc, J. M. (2017). A pilot study examining the speed and accuracy of triage for simulated disaster patients in an emergency department setting: Comparison of a computerized version of Canadian Triage Acuity Scale (CTAS) and Simple Triage and Rapid Treatment (START) methods. CJEM, 19(5), 364–371.

Dittmar, M. S. et al. (2018). Primary mass casualty incidente traige: evidence for the benefit of yearly brief re-training from a simulation study. Scand J Trauma Resusc Emerg Med, 26 (1), 35.

Ferreira, B. S. S.; Rocha, R. V. C.; & Oliveira, W. E. (2020). Importância da triagem no atendimento pré-hospitalar em incidentes com múltiplas vítimas. Trabalho de Conclusão de Curso (Bacharelado em Enfermagem) – Centro Universitário do Planalto Central Apparecido dos Santos, UNICEPLA, Gama- DF.

Franc, J. M. et al. (2022). METASTART: A Systematic Review and Meta-Analysis of the Diagnostic Accuracy of the Simple Triage and Rapid Treatment (START) Algorithm for Disaster Triage. Prehospital and disaster medicine, 37(1), 106–116.

Gamberini, L. (2021). Mass casualty management after a boiling liquid expanding vapor explosion in an urban area. The Journal of Emergency Medicine, 60(4), 471-477.

Gebhart, M. E., & Pence, R. (2007). START triage: does it work?. Disaster management & response. The Emergency Nurses Association, 5(3), 68–73.

Hong, R. et al. (2015). Comparison of START triage categories to emergency department triage levels to determine need for urgent care and to predict hospitalization. American Journal of Disaster Medicine, 10(1), 13-21.

Lima, D. S. (2018). Noções em incidentes com múltiplas vítimas. Emergência e suporte imediato à vida. Fortaleza: Unichristus, 271-284.

Lima, D. S. et al. (2019). Simulação de incidente com múltiplas vítimas: treinando profissionais e ensinando universitários. Revista do Colégio Brasileiro de Cirurgiões, 46 (3).

Lin et al. (2020). Comparison between simple triage and rapid treatment and Taiwan Triage and Acuity Scale for the emergency department triage of victims following an earthquake-related mass casualty incident: a retrospective cohort study. World journal of emergency surgery : WJES, 15(1), 20.

McKee, C. H. et al. (2020). Comparing the Accuracy of Mass Casualty Triage Systems When Used in an Adult Population. Prehospital emergency care, 24(4), 515–524.

Melo, C. L.; Machado, B. C. A.; & Alexandre, Z. L. (2014). Características e limitações do método START no atendimento pré-hospitalar: revisão integrativa. Revista de enfermagem da UFPE online, (8), 2413-2421.

Mendes, K. D. S.; Silveira, R. C. C. P.; & Galvão, C. M. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto - Enfermagem, 17 (4), 758–764.

Oliveira, F. A. G. (2013). Análise do método START para triagem em incidentes com múltiplas vítimas: uma revisão sistemática. Monografia (Conclusão de curso) – Universidade Federal da Bahia, Salvador.

Price, M. F. et al. (2018). Comparison of the Simple Triage and Rapid Treatment system versus the Prehospital Advanced Triage Model in multiple-casualty events. Comparación de los sistemas de triaje META y START en un ejercicio simulado de múltiples víctimas. Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias, 30(4), 224–230.

Storpirtis, S.; Nicoletti, M. A.; & Aguiar, P. M. (s.d.). Uso da simulação realística como mediadora do processo ensino-aprendizagem: relato de experiência da farmácia universitária da Universidade de São Paulo. Rev Grad USP, 1 (2), 45-55.

Teixeira, W. A. & Olcerenko, D. R. (2007). A utilização do método START em acidentes com múltiplas vítimas. 10° Congresso de Iniciação Científica, 4ª mostra pós-graduação e 1ª mostra do ensino médio.

Published

18/11/2022

How to Cite

MONTAGNER, G.; SOUSA, K. K. I. de; SANTOS, M. V. F. dos. Accuracy of the Simple Triage and Rapid Treatment (START) algorithm in accident and disaster triage: an integrative review. Research, Society and Development, [S. l.], v. 11, n. 15, p. e314111537234, 2022. DOI: 10.33448/rsd-v11i15.37234. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/37234. Acesso em: 9 feb. 2023.

Issue

Section

Review Article