Accuracy of Trauma on Scene Triage Screening Tool (Shock Index, Reverse Shock Index Glasgow Coma Scale and National Early Warning Score) to Predict the Severity of Emergency Department Triage: A Retrospective Cross-Sectional Study

Abstract

Introduction Prehospital trauma care includes on-scene assessments, essential treatment, and facilitating transfer to an appropriate trauma center to deliver optimal care for trauma patients. While the Simple Triage and Rapid Treatment (START), Revised Triage Sieve (rTS), and National Early Warning Score (NEWS) tools are user-friendly in a prehospital setting, there is currently no standardized on-scene triage protocol in Thailand Emergency Medical Service (EMS). Therefore, this study aims to evaluate the precision of these tools (SI, rSIG, and NEWS) in predicting the severity of trauma patients who are transferred to the emergency department (ED). Methods This study was a retrospective cross-sectional and diagnostic research conducted on trauma patients transferred by EMS to the ED of Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand, from January 2015 to September 2022. We compared the on-scene triage tool (SI, rSIG, and NEWS) and ED triage tool (Emergency Severity Index) parameters, massive transfusion protocol (MTP), and intensive care unit (ICU) admission with the area under ROC (univariable analysis) and diagnostic odds ratio (multivariable logistic regression analysis). The optimal cut-off threshold for the best parameter was determined by selecting the value that produced the highest area under the ROC curve. Results A total of 218 patients were traumatic patients transported by EMS to the ED, out of which 161 were classified as ESI levels 1–2, while the remaining 57 patients were categorized as levels 3–5 on the ESI triage scale. We found that NEWS was a more accurate triage tool to discriminate the severity of trauma patients than rSIG and SI. The area under the ROC was 0.74 (95% CI 0.70–0.79) (OR 18.98, 95% CI 1.06–337.25), 0.65 (95% CI 0.59–0.70) (OR 1.74, 95% CI 0.17–18.09) and 0.58 (95% CI 0.52–0.65) (OR 0.28, 95% CI 0.04–1.62), respectively (P-value <0.001). The cut point of NEWS to discriminate ESI levels 1–2 and levels 3–5 was >6 points. Conclusion NEWS is the best on-scene triage screening tool to predict the severity at the emergency department, massive transfusion protocol (MTP), and intensive care unit (ICU) admission compared with other triage tools SI and rSIG.

The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards

“…However, although promising, the use of the TTT algorithm results in a concerning over-triage, which may affect resource allocation. On the other hand, TTT does not need medical and instrumental interventions, such as blood pressure or heart/respiratory rate assessments, which could be an advantage in certain situations where such assessments are not possible or available, thus, offering a quicker triage performance, which can also be done by other staff than medical staff at the primary triage line [ 2 – 5 , 22 – 25 ].…”

“…On the other hand, by using an algorithm, such as the TTT, with no under-triage, preventable deaths can be avoided, and the use of other staff categories can be facilitated. In extreme situations when every available human resource is crucial for the outcome, using other staff with lower competencies, non-governmental agencies with diverse backgrounds, and even laypersons can save lives [ 22 , 25 ]. In such a situation, when flexibility in the management system is required [ 23 , 24 ], the use of a simple, and easy-to-perform algorithm such as TTT cannot be underestimated.…”

Association Between Platelet-to-Lymphocyte Ratio and In-hospital Mortality in Elderly Patients with Severe Trauma

“…Clinical instruments, such as the National Early Warning Score, Modified Early Warning Score), and Acute Physiology and Chronic Health Assessment (APACHE II) score, used in critically ill patients can help predict prognosis in patients with trauma. 5 , 6 Additionally, the Injury Severity Score (ISS), Revised Trauma Score, and Trauma and Injury Severity Score are commonly used tools in trauma. 7 – 9 However, these tools often have cumbersome evaluation processes and subjective assessments; therefore, easier and more objective prognostic predictors should be considered.…”