Validation of a novel irritant gas syndrome triage algorithm

Objective: Our objective was to validate a novel irritant gas syndrome agent (IGSA) triage algorithm for use in an emergency department (ED). We assessed efficiency, accuracy, and precision of our IGSA triage algorithm based on signs/symptoms of actual patients.Design: After characterizing the signs/symptoms of an actual IGSA exposure event, we developed and validated the IGSA triage algorithm using a simulated computer exercise to compare the IGSA triage algorithm to the preferred hospital triage algorithm, the Emergency Severity Index (ESI).Setting: This study was a simulated computer exercise using surveys developed in Research Electronic Data Capture software. Nurse volunteers simulated triaging 298 patients.Participants: Patient data included 146 patients treated during the disaster as well as 152 unexposed patients. Twenty-six nurse volunteers were assigned to triage the patients using one of the algorithms in the simulated computer exercise.Main Outcome Measure(s): The precision of the IGSA triage algorithm was 0.82 (confidence interval [CI] 0.78-0.85) and ESI 0.73 (CI 0.69-0.77). Weighted κ for ESI and IGSA accuracy for exposed patients was 0.32 (95% CI 0.26-0.37) and 0.81 (95% CI 0.77-0.85), respectively.Results: The IGSA triage algorithm was more accurate and precise than the ESI algorithm for triaging patients exposed to an irritant gas.Conclusions: This study validates the IGSA triage algorithm as the basis for the development of a prototype software application to quickly identify victims of a chemical disaster and triage patients efficiently and accurately with the potential to dramatically improve the processing of patients in EDs.