Mass Casualty Triage Validation Study

描述（由申请人提供）：在灾难性事件中对大量受伤患者的管理-无论是自然的，无意的还是故意的事件(例如：“所有危害事件”)可能迅速压倒现有的医疗资源，危及受害者和医疗服务提供者的生命。对于有效的大规模伤亡分诊所需的标准化定义或数据，目前还没有达成共识。没有结果研究验证涉及化学、放射性或生物材料的事故所需的数据，也没有结果研究适用于所有年龄的受害者。我们广泛的长期目标是验证分诊系统的准确性，该系统适用于有成年受害者的化学事件。我们提出了一项研究，使用大量氯泄漏的健康结果数据来确定四种分诊系统收集的数据是否能准确预测实际临床状态。从2005年发生的氯气泄漏中收集的六个数据集包括900多名受害者的患者人口统计、暴露估计、症状、结果类别和生理测量。根据这些数据发表的研究表明，血氧饱和度可预测急性医疗结果。这些数据将用于解决以下具体目标：1)通过链接来自六个氯泄漏数据集的实际数据，生成一个研究数据集，用于进一步分析，以探索完整性和稳健性的措施（以测试RQ1）。2)建立一个统计模型，使用医疗结果类别和血氧饱和度作为医疗结果的衡量标准，以比较四种成人分诊系统（以测试RQ1）。3)利用统计模型（SA2）和研究数据集（SA1）评估四种成人分诊系统准确预测医疗结果的能力。4)探索数据驱动模型的开发，使用研究数据集（SA1）对患者进行分类，以预测成人的医疗结果（以测试RQ2）。构建研究框架的研究问题：1)在美国最常用的四个成人分诊系统中收集的数据与从氯泄漏患者数据集中需要医疗干预的呼吸体征/症状的严重程度之间的关联是什么？2)对于涉及化学事故的初始治疗，成人大规模伤亡分诊系统中哪些附加信息能够充分提高分诊分类的准确性？

DESCRIPTION (provided by applicant): The management of large numbers of injured patients expected during catastrophic events - either from natural, unintended or deliberate incidents (e.g. 'all hazards events') could quickly overwhelm existing healthcare resources jeopardizing the lives of victims and healthcare providers. No consensus currently exists on standardized definitions or data needed for effective mass casualty triage. No outcome studies validate data needed for incidents involving chemical, radiological, or biological material, and none are appropriate for use with victims of all ages. Our broad long-term goal is to validate the accuracy of triage systems that are appropriate for use in chemical events with adult victims. We propose a study using health outcome data from a large chlorine leak to determine whether the data collected in four triage systems accurately predict actual clinical status. Six datasets collected from a chlorine leak that occurred in 2005 include patient demographics, exposure estimates, symptoms, outcome categories, and physiological measurements for more than 900 victims. Research studies published on these data indicate that oxygen saturation was predictive of acute medical outcomes. These data will be used to address the following specific aims: 1) Generate a research dataset useful for further analysis by linking actual data from six chlorine leak datasets to explore measures for completeness and robustness (to test RQ1). 2) Develop a statistical model using medical outcome categories and oxygen saturation levels as measures of medical outcome to compare four adult triage systems (to test RQ1). 3) Evaluate the ability of four adult triage systems to accurately predict medical outcomes using the statistical model (SA2) and research dataset (SA1). 4) Explore the development of a data driven model to triage patients using the research dataset (SA1) to predict medical outcomes for adults (to test RQ2). Research questions that frame the study: 1) What is the association between data collected in the four adult triage systems most frequently used in the U.S. and severity of respiratory signs/symptoms necessitating medical intervention from chlorine leak patient datasets? 2) What additional information in an adult mass casualty triage system sufficiently improves the prediction of an accurate triage classification for initial treatment that involves a chemical incident?