Does the simple triage and rapid treatment method appropriately triage patients based on trauma injury severity score?


  • Rick Hong, MD
  • Paul R. Sierzenski, MD
  • Melissa Bollinger, RN
  • Craig C. Durie, RN
  • Robert E. O’Connor, MD, MPH



simple triage and rapid treatment, START, trauma injury severity score, ISS


Objectives: To correlate the simple triage and rapid treatment (START) colors to trauma injury severity scores (ISS).
Design: Six volunteer healthcare providers unfamiliar with START were trained to triage. Each chart was designated a START color by a volunteer healthcare provider and the “expert” trainer. The colors and corresponding ISS were recorded.
Setting: Level I trauma center at a suburban tertiary care hospital.
Patients, participants: One hundred charts of patients at least 65 years old who appear in Christiana Hospital’s Trauma Registry were randomly chosen for the study, and 98 charts with complete data were included.
Main outcome measure(s): Cohen’s Kappa score measures the level of agreement between the “volunteer” and “expert” reviewers. Pearson correlation determines the association between the START colors and mean ISS.
Results: The Cohen’s Kappa score between the volunteer and expert reviewers was 0.9915, indicating a highly significant agreement between the reviewers on the triage category of the patients. The mean ISS for each color was as follows: green = 11, yellow = 12, red = 20, black = 24. The mean ISS increases as the acuity of the triage category increases, with a Pearson correlation of 0.969.
Conclusions: The START method is a simple technique used to triage quickly a large number of patients. Healthcare providers can undergo just-in-time training to learn this technique and use it effectively.The START colors also imply a correlation with the trauma ISS, with higher ISS more likely to be triaged “red” or “black.”

Author Biographies

Rick Hong, MD

Head of Division of EMS and Disaster Medicine, Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey, and Medical Director, Public Health Preparedness Section, Delaware Division of Public Health, Smyrna, Delaware.

Paul R. Sierzenski, MD

Director of Emergency Medicine Ultrasound, Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.

Melissa Bollinger, RN

Emergency Medicine Research, Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.

Craig C. Durie, RN

Emergency Medicine Research, Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.

Robert E. O’Connor, MD, MPH

Chair, Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia.


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How to Cite

Hong, MD, R., P. R. Sierzenski, MD, M. Bollinger, RN, C. C. Durie, RN, and R. E. O’Connor, MD, MPH. “Does the Simple Triage and Rapid Treatment Method Appropriately Triage Patients Based on Trauma Injury Severity Score?”. American Journal of Disaster Medicine, vol. 3, no. 5, Sept. 2008, pp. 265-71, doi:10.5055/ajdm.2008.0033.