Accuracy of Respiratory Rate Measurements in Triage During Exercises of Mass Casualties

Huei-Tsair Chen, MD; Aming Chor-Min Lin, MD; Tzong-Luen Wang, MD, PhD; Chi-Ren Hung, MD

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Abstract --Respiratory rate is one of the vital signs and determines the priority of patient disposition in any settings of emergency such as disasters or mass casualty incidents (MCIs). To assess the accuracy of measurements of respiratory rate in field triage (using Simplified Triage and Rapid Transportation, START), we compared the triage measurements of respiratory rate and criterion standard measurements of respiratory rate in consecutive subjects who have been assumed to be the victims of MCIs in 3 related exercises in 2004. After excluding those with missing measurements of respiratory rate, 96 subjects were enrolled for comparison between criterion standard measurements and triage measurements. Variability for triage staffs' measurements of respiratory rate was significantly lower than for criterion standard measurements of respiratory rate (SD 2.4 vs. 4.6; P <0.05). The sensitivity and specificity of triage measurement of respiratory rate in detecting bradypnea were 0% and 100%. The sensitivity and specificity of triage measurement of respiratory rate in detecting tachypnea was 54% and 93%, respectively. The correlation analysis showed unsatisfactory agreement between triage measurement of respiratory rate and criterion standard measurements of respiratory rate (r 2 =0.64, 95% CI 0.49 to 0.78). Because of dependency on the value of respiratory rate, priority made by START can be easily changed. We thus emphasize that measurement of respiratory rate in field triage should be performed according to criterion standard.