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Refining the trauma triage algorithm at an Australian major trauma centre: derivation and internal validation of a triage risk score

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To derive and internally validate a clinical prediction rule for trauma triage.

Methods

Ambulance presentations requiring trauma team activation between 2007 and 2011 at a single inner city major trauma centre were analysed. The primary outcome was major trauma, defined as Injury Severity Score >15, intensive care unit admission or in-hospital death. Demographic details, vital signs on arrival at hospital, mechanism of injury and injured body regions were used in the modelling process. Multivariable logistic regression was used on a randomly selected derivation sample. Receiver operating characteristic (ROC) analysis and Hosmer–Lemeshow tests were used to assess the discrimination and calibration of the derived model. The model was further tested using bootstrapping cross-validation.

Results

A total of 3027 patients were identified. Predictors selected for the prediction model were age ≥65 years (OR 1.58, 95 %CI 1.08–2.32, p = 0.02), abnormal vital signs (OR 3.72, 95 %CI 2.64–5.25), Glasgow Coma Scale score ≤13 (OR 14, 95 %CI 9.23–23.34 p < 0.001), penetrating injury (OR 5.13, 95 %CI 2.76–9.54, p < 0.001), multiregion injury (OR 4.72 95 %CI 3.45–6.46, p < 0.001), falls (OR 1.51 95 %CI 1.06–2.15, p = 0.02) and motor vehicle crashes (OR 0.56, 95 %CI 0.35–0.90, p = 0.02). The ROC area under the curve (AUC) for the final model was 0.85 (95 %CI 0.83–0.87) with a Hosmer–Lemeshow test statistic p = 0.83. Bootstrapping cross-validation demonstrated an identical AUC.

Conclusion

We have derived and internally validated a trauma risk prediction rule using trauma registry data. This may assist with the formulation of revised local and regional trauma triage protocols. External validation is required before implementation.

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References

  1. Mackersie RC. History of trauma field triage development and the American College of Surgeons criteria. Prehosp Emerg Care. 2006;10(3):287–94.

    Article  PubMed  Google Scholar 

  2. O’Connor RE. Trauma triage: concepts in prehospital trauma care. Prehosp Emerg Care. 2006;10(3):307–10.

    Article  PubMed  Google Scholar 

  3. American College of Surgeons, Committee on Trauma. Resources for optimal care of the injured patient 2006. Chicago: American College of Surgeons; 2006.

  4. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma. 1989;29(5):623–9.

    Article  CAS  PubMed  Google Scholar 

  5. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma score and the injury severity score. J Trauma. 1987;27(4):370–8.

    Article  CAS  PubMed  Google Scholar 

  6. Gormican SP. CRAMS scale: field triage of trauma victims. Ann Emerg Med. 1982;11(3):132–5.

    Article  CAS  PubMed  Google Scholar 

  7. Kirkpatrick JR, Youmans RL. Trauma index. An aide in the evaluation of injury victims. J Trauma. 1971;11(8):711–4.

    Google Scholar 

  8. Koehler JJ, Baer LJ, Malafa SA, Meindertsma MS, Navitskas NR, Huizenga JE. Prehospital index: a scoring system for field triage of trauma victims. Ann Emerg Med. 1986;15(2):178–82.

    Article  CAS  PubMed  Google Scholar 

  9. Tamim H, Joseph L, Mulder D, Battista RN, Lavoie A, Sampalis JS. Field triage of trauma patients: improving on the prehospital index. Am J Emerg Med. 2002;20(3):170–6.

    Article  PubMed  Google Scholar 

  10. Lerner EB. Studies evaluating current field triage: 1966–2005. Prehosp Emerg Care. 2006;3:303–6.

    Article  Google Scholar 

  11. Dinh MM, Oliver M, Roncal S, Bein KJ, Byrne C. Performance of the New South Wales Ambulance Service major trauma transport protocol (T1) at an inner city trauma centre. Emerg Med Australas. 2012;4:401–7.

    Article  Google Scholar 

  12. Ciesla DJ, Sava JA, Street JH, Jordan MH. Secondary overtriage: a consequence of an immature trauma system. J Am Coll Surg. 2008;206(1):131–7.

    Article  PubMed  Google Scholar 

  13. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–78.

    Article  CAS  PubMed  Google Scholar 

  14. Phillips S, Rond PC 3rd, Kelly SM, Swartz PD. The failure of triage criteria to identify geriatric patients with trauma: results from the Florida Trauma Triage Study. J Trauma. 1996;40(2):278–83.

    Google Scholar 

  15. Mohan D, Rosengart MR, Farris C, Cohen E, Angus DC, Barnato AE. Assessing the feasibility of the American College of Surgeons’ benchmarks for the triage of trauma patients. Arch Surg. 2011;146(7):786–92.

    Article  PubMed  Google Scholar 

  16. Sampalis JS, Lavoie A, Boukas S, et al. Trauma center designation: initial impact on trauma-related mortality. J Trauma. 1995;39(2):232–7.

    Article  CAS  PubMed  Google Scholar 

  17. Davis T, Dinh M, Roncal S, et al. Prospective evaluation of a two-tiered trauma activation protocol in an Australian major trauma referral hospital. Injury. 2010;41(5):470–4.

    Article  PubMed  Google Scholar 

  18. Sullivan LM, Massaro JM, D’Agostino RB. Presentation of multivariate data for clinical use: the Framingham study risk score functions. Stat Med. 2004;23(10):1631–60.

    Article  PubMed  Google Scholar 

  19. Stiell IG, Wells GA. Methodological standards for the development of clinical decision rules in emergency medicine. Ann Emerg Med. 1999;33(4):437–47.

    Article  CAS  PubMed  Google Scholar 

  20. Chen L, Reisner AT, Gribok A, Reifman J. Exploration of prehospital vital sign trends for the prediction of trauma outcomes. Prehosp Emerg Care. 2009;13:286–94.

    Article  PubMed  Google Scholar 

  21. Meisel ZF, Pollack CV, Mechem CC, Pines JM. Derivation and internal validation of a rule to predict hospital admission in prehospital patients. Prehosp Emerg Care. 2008;12(3):314–9.

    Article  PubMed  Google Scholar 

  22. Gabbe BJ, Cameron PA, Wolfe R, Simpson P, Smith KL, McNeil JJ. Prehospital prediction of intensive care unit stay and mortality in blunt trauma patients. J Trauma. 2005;59(2):458–65.

    Article  PubMed  Google Scholar 

  23. Sartorius D, Le Manach Y, David JS, et al. Mechanism, Glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med. 2010;38(3):831–7.

    Article  PubMed  Google Scholar 

  24. Newgard CD, Rudser K, Hedges JR, et al. A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality. J Trauma. 2010;68(2):452–6.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Arbabi S, Jurkovich GJ, Wahl WL, et al. A comparison of prehospital and hospital data in trauma patients. J Trauma. 2004;56(5):1029–32.

    Article  PubMed  Google Scholar 

  26. Mulholland SA, Cameron PA, Gabbe BJ, et al. Prehospital prediction of the severity of blunt anatomic injury. J Trauma. 2008;64(3):754–60.

    Article  PubMed  Google Scholar 

  27. Scalea TM, Burgess AR. Pelvic fractures. In: Feliciano DV, Mattox KL, Moore EE, editors. Trauma. 5th ed. New York: McGraw-Hill Medical; 2004. p. 806.

    Google Scholar 

  28. Australia Bureau of Statistics. Deaths in motor vehicle accidents. 2012. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by+Subject/4125.0~Jan+2012~Main+Features~Deaths+in+motor+vehicle+accidents~3250. Last updated August 2012. (cited 7 Sept 2012).

  29. Curtis KA, Mitchell RJ, Chong SS, et al. Injury trends and mortality in adult patients with major trauma in New South Wales. Med J Aust. 2012;197(4):233–7.

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Ms Susan Roncal for data collection and Dr Shimon Shaykevich from the Harvard School of Public Health for assistance with cross-validation techniques.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Trauma Services, Royal Prince Alfred Hospital, Camperdown, Australia

    M. M. Dinh

  2. Emergency Department, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia

    M. M. Dinh, K. J. Bein & M. Oliver

  3. Sydney Medical School, University of Sydney, Sydney, Australia

    M. M. Dinh

  4. NHMRC Clinical Trials Centre, Camperdown, Australia

    A.-S. Veillard

  5. Injury Division, The George Institute for Global Health, Sydney, Australia

    R. Ivers

Authors
  1. M. M. Dinh
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  2. K. J. Bein
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  3. M. Oliver
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  4. A.-S. Veillard
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  5. R. Ivers
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Corresponding author

Correspondence to M. M. Dinh.

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Dinh, M.M., Bein, K.J., Oliver, M. et al. Refining the trauma triage algorithm at an Australian major trauma centre: derivation and internal validation of a triage risk score. Eur J Trauma Emerg Surg 40, 67–74 (2014). https://doi.org/10.1007/s00068-013-0315-1

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  • DOI: https://doi.org/10.1007/s00068-013-0315-1

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