Cross, K.P., Petry, M.J., and Cicero, M.X. (2015). A Better START for Low-Acuity Victims: Data-driven Refinement of Mass Casualty Triage. (Abstract only.) Prehospital Emergency Care. 19(2):272-8.
The authors used data from 322,162 subjects in the National Trauma Database (NTDB) to assess gaps of the START algorithm when it is used to triage low-acuity patients. They identified factors for mistriage of “Green/Minor” level patients who died in the hospital (N=2,046), and then developed and tested evidenced-based improvements to START using an iterative process. They concluded that START accuracy was significantly improved when elderly, but otherwise minimally injured patients were triaged as “Yellow” instead of “Green.”