Assessment of earthquake casualties and comparison of accuracy of five injury triage methods: evidence from a retrospective study

OBJECTIVE: The use of an injury triage method among earthquake injury patients can facilitate the reasonable allocation of resources, but the various existing injury triage methods need further confirmation. This study aims to assess the accuracy of several injury triage methods, namely, the Simple Triage and Rapid Treatment (START) technique; CareFlight Injury Triage (CareFlight); Rapid Emergency Medicine Score (REMS); Triage Revised Trauma Score (T-RTS) and Triage Early Warning Score (TEWS), based on their effects on earthquake injury patients. DESIGN: Data in the Huaxi Earthquake Casualty Database were analysed retrospectively. SETTING: This study was conducted in China. PARTICIPANTS: Data on 29 523 earthquake casualties were separately evaluated using the START technique, CareFlight, REMS, T-RTS and TEWS, with these being the five types of injury triage studied. PRIMARY OUTCOME MEASURE: The receiver operating characteristic (ROC) curves for the five injury triages were calculated based on hospital deaths, injury severity scores greater than 15 points, and whether casualties stayed in the intensive care unit. RESULTS: The ROC curve areas of the START technique, CareFlight, REMS, T-RTS and TEWS were 0.750, 0.737, 0.835, 0.736 and 0.797, respectively. Among the five injury triages, the most accurate in predicting hospital deaths was REMS, with an average area under the curve (AUC) of 0.835, with this due to the inclusion of more evaluation indicators. CONCLUSION: All methods had an effect on the triage of earthquake mass casualties. Among them, the REMS injury triage method had the largest AUC of the five triage methods. Except for REMS, no obvious difference was found in the effect of the other four injury triage methods.