Validating Signs and Symptoms From An Actual Mass Casualty Incident to Characterize An Irritant Gas Syndrome Agent (IGSA) Exposure: A First Step in The Development of a Novel IGSA Triage Algorithm.
Joan M Culley, Jane Richter, Sara Donevant and 3 others
PMID 28363626WHAT IT FOUND
Existing symptom-mapping tools correctly identified 84% to 97% of chlorine-exposed patients, but only 29% to 47% of unexposed patients were correctly identified as not exposed.
Exposed patients still need monitoring for delayed breathing problems.
Key findings
01Sensitivity was .84 to .94 for WISER and .92 to .97 for CHEMM-IST, but specificity was .31 to .47 and .29 to .33, respectively. The tools usually caught exposed patients but often wrongly flagged unexposed patients.
02False negative probability was .06 to .16 for WISER and .03 to .08 for CHEMM-IST, while false positive probability was .53 to .69 and .67 to .71. Exposed patients were rarely missed, but unexposed patients were often wrongly flagged.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used data from one chlorine incident, and the exposure was mainly inhalational, so it may not apply to other chemicals, routes, or incidents. The sample was small, and data were missing or difficult to collect. Records were paper forms with conflicting information, missing times, illegible entries, and unconventional abbreviations; three emergency nurses resolved problems by conference. The study did not test a triage algorithm or patient outcomes; it is a first step toward a proposed IGSA triage tool.
The easy way to misread this
Do not conclude that a positive WISER or CHEMM-IST screen proves chlorine exposure. The tools had poor specificity and high false positive probability, and the IGSA triage algorithm was only a proposed next step, not a tested tool.