Accuracy of EMS Trauma Transport Destination Plans in North Carolina

Moss, Chailee; Cowden, Christopher S.; Atterton, Laurie M.; Arasaratnam, Meredith H.; Fernández, Antonio R. Martínez; Evarts, Jeff S.; Barrier, Brian; Lerner, E. Brooke; Mann, N. Clay; Lohmeier, Chad; Shofer, Frances S.; Brice, Jane H.

doi:10.3109/10903127.2014.916021

Cited by 5 publications

(2 citation statements)

References 8 publications

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“…Field triage algorithms constitute a valuable aide for pre-hospital teams but should not be a substitute for clinical common sense. It is important to be aware of all the technical resources provided by TC platforms in order to ensure optimal management and to limit undertriage as much as possible [35]. Further studies are required in order to compile exhaustive and optimal pre-hospital triage criteria or algorithms that can aide physicians in their decision-making for appropriate referrals of a trauma patient to their right place at the right time [36].…”

Section: Discussionmentioning

confidence: 99%

Correlation between field triage criteria and the injury severity score of trauma patients in a French inclusive regional trauma system

Cassignol¹,

Marmin²,

Cotté

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background In France, the pre-hospital field triage of trauma patients is currently based on the Vittel criteria algorithm. This algorithm was originally created in 2002 before the stratification of trauma centers and, at the national level, has not been revised since. This could be responsible for the overtriage of trauma patients in Level I Trauma Centers. The principal aim of this study was to evaluate the correlation between each Vittel field triage criterion and trauma patients’ Injury Severity Score. Methods Our Level I Trauma Center receives an average of 300 trauma patients per year. Demographic and physiological data, along with the entire trauma patient management process and Vittel field triage criteria, are recorded in a local trauma registry. The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are calculated after a complete assessment of the trauma victim during their in-hospital management. Results were concerned with the presence of an ISS of greater than 15, which defined a major trauma patient; mortality within 30 days; and admission to the intensive care unit. This study is a registry analysis from January 2013 to September 2017. Results Of the 1373 patients in the registry, 1151 were included in the analysis with a mean age of 43 years (± 19) and a median ISS of 13 (IQR = 5–22), where 887 (77%) were male. Nine of the 24 Vittel criteria were associated with an ISS > 15. In a multivariate analysis, no criterion related to kinetic elements was significantly correlated with an ISS > 15, mortality within 30 days, or admission to intensive care. Three algorithm categories were predictive of a major trauma patient (ISS > 15): physiological variables, pre-hospital resuscitation, and physical injuries, while kinetic elements were not. Conclusions Criteria related to physiological variables, pre-hospital resuscitation, and physical injuries are the most relevant to predicting the severity of a trauma patient’s condition. A revision of the VCA could potentially have beneficial effects on the over and undertriage phenomena, which constitute ongoing medical and financial concerns.

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Section: Discussionmentioning

confidence: 99%

Correlation between field triage criteria and the injury severity score of trauma patients in a French inclusive regional trauma system

Cassignol¹,

Marmin²,

Cotté

et al. 2019

Scand J Trauma Resusc Emerg Med

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“…They also reported various systems of quality assurance to confirm EMS personnel use in the field. 19 However, neither compliance with these plans for older adults nor the effect of the plans on the triage of injured older adults have been studied. Another study recently examined the implementation of the NC TTDP for all patients and did not observe changes in trauma center transportation for those meeting TTDP criteria.…”

Section: Introductionmentioning

confidence: 99%

The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan

Meyers

Wei

Cyr

et al. 2019

Prehosp. Disaster med.

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Introduction:In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.Hypothesis/Problem:The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.Methods:This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.Results:The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.Conclusions:State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.

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