Field triage in trauma – do the data really justify the conclusions? (original) (raw)
2009, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Dear Sir, I read with interest the recently published paper by Rehn and coworkers about field triage in trauma . The topic is interesting and improved quality of the work and information flow from the scene-of-the-accident to the emergency department can save lives. However, some of the conclusions drawn by the authors can be challenged.
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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2009
Background: Field triage is important for regional trauma systems providing high sensitivity to avoid that severely injured are deprived access to trauma team resuscitation (undertriage), yet high specificity to avoid resource overutilization (overtriage). Previous informal trauma team activation (TTA) at Ulleval University Hospital (UUH) caused imprecise triage. We have analyzed triage precision after introduction of TTA guidelines.
Accuracy of trauma triage in patients transported by helicopter
Air Medical Journal, 1996
Introduction: Our objective was to study the accuracy of the American College of Surgeons Trauma Triage Scheme in trauma patients transported by helicopter from the scene of injury.Methods: This is a case series of 333 patients transported by helicopter from the scene of injury to a University Hospital Level 1 Trauma Center. We constructed 2 × 2 tables with the use of Injury Severity Score > 15 as the “gold standard” for major trauma and assessed the Trauma Triage Scheme (overall) and its physiologic, situational, and age/comorbidity components individually.Results: Physiologic criteria had high specificity (85.7%) but low sensitivity (55.6%), whereas situational criteria had high sensitivity (86.6%) but low specificity (19.9%). Use of physiologic criteria alone would miss 67 of 151 patients with Injury Severity Score > 15 and five of 31 fatalities. Situational criteria capture 58 of the 67 major trauma patients missed by the physiologic criteria but also 125 minor trauma patients. Age/comorbidity criteria had low positive (22.7%) and negative (10%) predictive values.Conclusions: Physiologic triage criteria alone identify only half of trauma patients with Injury Severity Score > 15. Situational criteria are needed to identify most patients with Injury Severity Score > 15, but this also captures many patients with minor injury. If the Trauma Triage Scheme situational criteria could be improved, trauma overtriage might be reduced with resultant health care cost savings.
European Journal of Emergency Medicine, 2011
Link to publication in VU Research Portal citation for published version (APA) Giannakopoulos, G. F. (2012). Triage and assessment of injuries in early trauma care. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Cancellations of Helicopter Emergency Medical Services dispatches in the Netherlands
2010
Triage and assessment of injuries in early trauma care Giannakopoulos, G.F. 2012 document version Publisher's PDF, also known as Version of record Link to publication in VU Research Portal citation for published version (APA) Giannakopoulos, G. F. (2012). Triage and assessment of injuries in early trauma care. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
European Journal of Trauma and Emergency Surgery, 2017
Purpose To find ways to reduce the rate of over-triage without drastically increasing the rate of under-triage, we applied a current guideline and identified relevant pre-hospital triage predictors that indicate the need for immediate evaluation and treatment of severely injured patients in the resuscitation area. Methods Data for adult trauma patients admitted to our level-1 trauma centre in a one year period were collected. Outpatients were excluded. Correct triage for trauma team activation was identified for patients with an ISS or NISS ≥ 16 or the need for ICU treatment due to trauma sequelae. In this retrospective analysis, patients were assigned to trauma team activation according to the S3 guideline of the German Trauma Society. This assignment was compared to the actual need for activation as defined above. 13 potential predictors were retained. The relevance of the predictors was assessed and 14 models of interest were considered. The performance of these potential triage models to predict the need for trauma team activation was evaluated with leave-one-out cross-validated Brier and logarithmic scores. Results A total of 1934 inpatients ≥ 16 years were admitted to our trauma department (mean age 48 ± 22 years, 38% female). Sixty-nine per cent (n = 1341) were allocated to the emergency department and 31% (n = 593) were treated in the resuscitation room. The median ISS was 4 (IQR 7) points and the median NISS 4 (IQR 6) points. The mortality rate was 3.5% (n = 67) corresponding to a standardized mortality ratio of 0.73. Under-triage occurred in 1.3% (26/1934) and overtriage in 18% (349/1934). A model with eight predictors was finally selected with under-triage rate of 3.3% (63/1934) and over-triage rate of 10.8% (204/1934). Conclusion The trauma team activation criteria could be reduced to eight predictors without losing its predictive performance. Non-relevant parameters such as EMS provider judgement, endotracheal intubation, suspected paralysis, the presence of burned body surface of > 20% and suspected fractures of two proximal long bones could be excluded for full trauma team activation. The fact that the emergency physicians did a better job in reducing under-triage compared to our final triage model suggests that other variables not present in the S3 guideline may be relevant for prediction.
Emergency Medicine Journal, 2010
Background and aim Prehospital care of trauma patients is a matter of great debate. The optimal transport method remains undecided, with conflicting data comparing helicopter and ground emergency medical transfer. This study systematically reviews the evidence comparing helicopter and ground transfer of trauma patients from the scene of injury. Methods A systematic literature review of all population-based studies evaluating the impact on mortality of helicopter transfer of trauma patients from the scene of injury. We searched MEDLINE, CINAHL and EMBASE from January 1980 to December 2008 and selected and reviewed potentially relevant studies. Results A search of the literature revealed 23 eligible studies. 14 of these studies demonstrated a significant improvement in trauma patient mortality when transported by helicopter from the scene. 5 of the 23 studies were of level II evidence with the remainder being of level III evidence. Data were then entered into an evidence table and reference made to transport staffing, intubation rate, time at scene and time/distance of transfer. Conclusions The role and structure of HEMS in a modern trauma service is a debate that is likely to continue. Prehospital care design should be specific to critical incident frequency, geographical arrangements of hospital facilities and travel times within each trauma network. It is also important to consider the benefits and capabilities of the emergency medical team separately from the transport method being considered. An effective helicopter EMS will ultimately depend on effective operating procedures and tasking protocols, clinical governance, and auditing of the helicopter EMS activity.
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