Evaluation of Pediatric Triage Decisions Using the SALT (Sort, Assess, Life-saving Intervention, Treatment/Transport) Triage System across Training Levels

Objective Evaluate and improve the accuracy of disaster triage decisions for pediatric patients among clinicians of various training levels using the Sort, Assess, Life-Saving Intervention, Treatment/Transport (SALT) triage system. Methods We used an online pediatric disaster triage module to evaluate and improve accuracy of triage decisions. During a pre- and post-test activity, participants triaged 20 fictional patients. Between activities, participants completed a didactic covering concepts of disaster triage, SALT triage, and pediatric limitations of triage systems. We assessed accuracy and improvement with non-parametric tests. Results There were 48 participants: 27 pediatric emergency medicine attendings (56%), 9 pediatric emergency medicine fellows (19%), 12 pediatric residents (25%). The median (interquartile range [IQR]) pre-test percent accuracy across all participants was 75 (IQR 65-85). Attendings scored higher than residents 80 (IQR 73-88) compared to 60 (IQR 55-65, P < 0.01) but not significantly higher than fellows 75 (IQR 70-85, P = 0.6). For the 44 participants who completed both the pre- and post-test, median score significantly improved from 75 (65-85) to 80 (75-90), P < 0.01. Conclusions The accuracy of triage decisions varies at different training levels. An online module can deliver just-in-time triage training and improve accuracy of triage decisions for pediatric patients, especially among pediatric residents.