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The prospective validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to major incident triage
  1. James Vassallo1,2,
  2. S Horne3,
  3. J E Smith3,4 and
  4. L A Wallis1
  1. 1 Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
  2. 2 Institute of Naval Medicine, Hampshire, UK
  3. 3 Emergency Department, Derriford Hospital, Plymouth, UK
  4. 4 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Dr James Vassallo, Institute of Naval Medicine, Alverstoke, Gosport, PO12 2DL, UK; vassallo{at}


Introduction Triage is a key principle in the effective management of major incidents. There is limited evidence to support existing triage tools, with a number of studies demonstrating poor performance at predicting the need for a life-saving intervention. The Modified Physiological Triage Tool (MPTT) is a novel triage tool derived using logistic regression, and in retrospective data sets has shown optimum performance at predicting the need for life-saving intervention.

Materials and methods Physiological data and interventions were prospectively collected for consecutive adult patients with trauma (>18 years) presenting to the emergency department at Camp Bastion, Afghanistan, between March and September 2011. Patients were considered priority 1 (P1) if they received one or more interventions from a previously defined list. Patients were triaged using existing triage tools and the MPTT. Performance was measured using sensitivity and specificity, and a McNemar test with Bonferroni calculation was applied for tools with similar performance.

Results The study population comprised 357 patients, of whom 214 (59.9%) were classed as P1. The MPTT (sensitivity: 83.6%, 95% CI 78.0% to 88.3%; specificity: 51.0%, 95% CI 42.6% to 59.5%) outperformed all existing triage tools at predicting the need for life-saving intervention, with a 19.6% absolute reduction in undertriage compared with the existing Military Sieve. The improvement in undertriage comes at the expense of overtriage; rates of overtriage were 11.6% higher with the MPTT than the Military Sieve. Using a McNemar test, a statistically significant (p<0.001) improvement in overall performance was demonstrated, supporting the use of the MPTT over the Military Sieve.

Discussion and conclusions The MPTT outperforms all existing triage tools at predicting the need for life-saving intervention, with the lowest rates of undertriage while maintaining acceptable levels of overtriage. Having now been validated on both military and civilian cohorts, we recommend that the major incident community consider adopting the MPTT for the purposes of primary triage.

  • Triage
  • Major incidents
  • Life-saving interventions

Statistics from


  • Contributors JV and SH conceived the study. SH collected the data. JV conducted the analysis, supervised by JES. JV drafted the manuscript, and all authors contributed substantially to its revision. JV takes responsibility for the paper as a whole.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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