A procedure based alternative to the injury severity score for major incident triage of children: results of a Delphi consensus process

Background: Triage at the site of a major incident is key to effective scene management. A number of triage algorithms have been suggested to assist the triage officer to determine triage priorities. However, many advocated scores were not specifically developed for use in major incidents, nor are they designed for multiple age groups. Many of these algorithms have not been validated: those that have were validated against the Injury Severity Score, which is of little relevance in a major incident - it is the urgency of medical intervention that is of importance in this setting. Objectives: To develop a set of criteria against which major incident triage algorithms can be tested. Methods: Sixteen experts from the UK and South Africa took part in a three round Delphi consensus method in order to develop clinical criteria against which major incident triage algorithms may be tested. Results: Thirty nine statements were initially identified as possible determinants of triage priority: 29 statements reached consensus. These associate specific clinical interventions with triage priority. Conclusion: Delphi may be used to identify which clinical criteria define triage priority in a major incident setting. These criteria and the associated triage categories may be used as for the validation of specific major incident triage algorithms. This method may be used to develop specific criteria for other triage algorithms.