Simple Triage and Rapid Treatment (START) algorithm for triage after a disaster

Added June 8, 2022

Citation: Franc JM, Kirkland SW, Wisnesky UD, Campbell S, Rowe BH. 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. 2022:37(1):106-16.

Language: Abstract and full text available in EN.  

Free to view: No.

Funding sources: Emergency Strategic Clinical Network, Alberta Health Services and the Emergency Medicine Research Group in the Department of Emergency Medicine at the University of Alberta; Canadian Institutes of Health Research.

What is this? Disaster triage aims to use resources efficiently and improve patient outcomes. The Simple Triage and Rapid Treatment (START) algorithm is a tool intended to help with patient triage after a disaster.

In this systematic review, the authors searched for studies of the accuracy of the START method including the accuracy of its categories: red, yellow, green, and black in adults (≥17 years). They did not restrict their searches by language of publication and searched for articles published between 1984 and March 2020. They included 32 studies, some of which could be included in meta-analyses.

What was found: These was significant heterogeneity in the results of the studies for all outcomes.

Using the START triage method, the proportion of correctly triaged victims ranged between 27% and 99%.

For the START categories, the proportion of correctly triaged cases was between 40% and 95% for red, 49% to 87% (yellow), 70% to 94% (green) and 58% to 98% (black).

Implications: The authors of the review concluded that although the START triage tool may be comparable in accuracy to other triage tools, a more accurate triage tool should be developed.

Other considerations: The authors of the review discussed their findings in the context of occupation, education and time-dependent relationships (triage and access to care).


This summary was prepared by Yasmeen Saeed and finalized by Mike Clarke.

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