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ISS is not an appropriate tool to estimate overtriage

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of this work is to study a cohort of patients of ISS < 15 admitted to a TC, and to determine the number of patients that ultimately benefited from the skills and resources specific of a level 1 trauma center.

Methods

Retrospective study from a prospective cohort of patients admitted to TC (Beaujon Hospital, APHP) for suspected severe trauma from January 2011 to December 2017. The main outcome criterion was the use of surgery or interventional radiology within the first 24 h after admission of patients with ISS < 15. The secondary outcomes were stratified into severe (mortality, resuscitation care, length of stay in intensive care units) and non-severe criteria (mild head injury, hospital discharge or transfer within 24 h).

Results

Of 3035 patients admitted during the study period, 1409 with an ISS < 15 were included, corresponding to a theoretical overtriage rate of 46.4%. Among these, 611 patients (43.4%) underwent emergency intervention within the first 24 h (586 surgical interventions, 19 direct transfers to the operating theater and 6 acts of interventional radiology), 238 (16.9%) of patients presented with severe and 531 (38%) with non-severe outcome criteria.

Conclusion

This work demonstrates that in a cohort of patients classified as ISS < 15 admitted to a TC, a considerable amount of TC-specific resources are required, and patients present with severe outcome criteria despite being classified as overtriaged. These results suggest that triage of trauma patients should be based on resource use and clinical outcome rather than anatomic criteria.

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Data availability

All data and materials are available for consultation.

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Funding

No funding was provided for this work.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France

    Paër-sélim Abback, Jean-Denis Moyer, Mathilde Holleville, Camille Hego, Caroline Jeantrelle, Hélène Bout, Isabelle Rennuit, Arnaud Foucrier, Anaïs Codorniu, Igor Jurcisin, Catherine Paugam-Burtz & Tobias Gauss

  2. Department of Anaesthesia and Intensive Care, Robert-Debré University Hospital, APHP, Paris, France

    Kelly Brouns

  3. Université de Paris, Paris, France

    Catherine Paugam-Burtz

Authors
  1. Paër-sélim Abback
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  2. Kelly Brouns
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  3. Jean-Denis Moyer
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  4. Mathilde Holleville
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  7. Hélène Bout
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  11. Igor Jurcisin
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  12. Catherine Paugam-Burtz
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  13. Tobias Gauss
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Contributions

PSA was responsible for conception, study design, data analysis and writing. KB was responsible for data collection and analysis. TG, JDM and CPB were responsible for critical revision. HB, IR, IJ, AF, MH, AC, CJ and CH were responsible for data collection.

Corresponding author

Correspondence to Paër-sélim Abback.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

Data for this study were extracted from a prospective registry with approval from the institutional review board (Comité de Protection des Personnes, Paris VI and Clermont-Ferrand), the Advisory Committee for Information Processing inHealth Research (Comite Consultatif Pour le Traitement de l’Information en Matière de Recherche Dans le Domaine de la Santé, 11.305bis and15.038bis), and from the National Data Protection Agency (Commission Nationale de l’Informatique et des Libertés 911461 and 915372), waiving the need for informed consent.

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Abback, Ps., Brouns, K., Moyer, JD. et al. ISS is not an appropriate tool to estimate overtriage. Eur J Trauma Emerg Surg 48, 1061–1068 (2022). https://doi.org/10.1007/s00068-021-01637-9

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  • DOI: https://doi.org/10.1007/s00068-021-01637-9

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