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Which pre-hospital triage parameters indicate a need for immediate evaluation and treatment of severely injured patients in the resuscitation area?

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Abstract

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 over-triage 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.

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Acknowledgements

We thank D. Lanzi for basic data management.

Author information

Authors and Affiliations

  1. Department of Trauma, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    K. O. Jensen, D. Schmitt, L. Mica, C. Ossendorf, H. P. Simmen, G. A. Wanner, C. M. L. Werner & K. Sprengel

  2. Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

    R. Heyard & L. Held

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  1. K. O. Jensen
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Correspondence to K. O. Jensen.

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Ethical approval

Approval by the local ethics committee was obtained for the analysis (KEK-ZH-Nr. 2013-0037). The study was conducted according to our institutional guidelines for good clinical practice and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. Due to this ethical approval no consent to participate in the study was needed, because only anonymised data were used.

Conflict of interest

Jensen KO, Heyard R, Schmitt D, Mica L, Ossendorf C, Simmen HP, Wanner GA, Werner CML, Held L and Sprengel K declare that they have no conflict of interest.

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Jensen, K.O., Heyard, R., Schmitt, D. et al. Which pre-hospital triage parameters indicate a need for immediate evaluation and treatment of severely injured patients in the resuscitation area?. Eur J Trauma Emerg Surg 45, 91–98 (2019). https://doi.org/10.1007/s00068-017-0889-0

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  • DOI: https://doi.org/10.1007/s00068-017-0889-0

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