Compliance to prehospital trauma triage protocols worldwide: A systematic review

Rein, Eveline A. J. van; Sluijs, Rogier van der; Raaijmaakers, Antoine M.R.; Leenen, Luke P. H.; Heijl, Mark van

doi:10.1016/j.injury.2018.07.001

Cited by 37 publications

(25 citation statements)

References 47 publications

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“…The scientific community is keen to conceptualize the most appropriate triage system, with interesting systematic reviews in this regard. 11,[40][41][42][43] These results to predict early mortality are superior to data presented in other studies with different triage systems to predict early mortality. 8,9,44,45 Triage represents a powerful diagnostic tool for the proper functioning of health systems.…”

Section: Discussionmentioning

confidence: 59%

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Martin-Rodríguez

López-Izquierdo

Vegas

et al. 2019

Prehosp. Disaster med.

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Introduction:In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.Hypothesis/Problem:The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.Methods:This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.Results:From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).Conclusion:Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).

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Section: Discussionmentioning

confidence: 59%

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Martin-Rodríguez

López-Izquierdo

Vegas

et al. 2019

Prehosp. Disaster med.

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“…26 However, compliance to frailty attuned scores in prehospital care may impact their effectiveness in such setting as previous evidence showed that paramedics' compliance with trauma triage tools varied from a rate of 21% to 93%. 27 Whilst there is reasonable evidence that care in MTCs benefits younger patients with severe injuries, it is uncertain whether or not the same benefits will accrue to injured older adults. This could be partially due to the lack of trauma-specific outcome measures for older people, 28 thereby limiting the determination of benefits of MTC access.…”

Section: Scope Of the Problemmentioning

confidence: 99%

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

Alshibani¹,

Banerjee²,

Lecky³

et al. 2021

OAEM

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Caring for older people is an important part of prehospital practice, including appropriate triage and transportation decisions. However, prehospital triage criteria are designed to predominantly assess injury severity or high-energy mechanism which is not the case for older people who often have injuries compounded by multimorbidity and frailty. This has led to high rates of under-triage in this population. This narrative review aimed to assess aspects other than triage criteria to better understand and improve prehospital triage decisions for older trauma patients. This includes integrating frailty assessment in prehospital trauma triage, which was shown to predict adverse outcomes for older trauma patients. Furthermore, determining appropriate outcome measures and the benefits of Major Trauma Centers (MTCs) for older trauma patients should be considered in order to direct accurate and more beneficial prehospital trauma triage decisions. It is still not clear what are the appropriate outcome measures that should be applied when caring for older trauma patients. There is also no strong consensus about the benefits of MTC access for older trauma patients with regards to survival, in-hospital length of stay, discharge disposition, and complications. Moreover, looking into factors other than triage criteria such as distance to MTCs, patient or relative choice, training, unfamiliarity with protocols, and possible ageism, which were shown to impact prehospital triage decisions but their impact on outcomes has not been investigated yet, should be more actively assessed and investigated for this population. Therefore, this paper aimed to discuss the available evidence around frailty assessment in prehospital care, appropriate outcome measures for older trauma patients, the benefits of MTC access for older patients, and factors other than triage criteria that could adversely impact accurate prehospital triage decisions for older trauma patients. It also provided several suggestions for the future.

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“…7 The likelihood of non-major TC transportation increases by the age of 60 years 8 even when TC prehospital triage criteria are met. 7,[9][10][11] As the population is aging, 12 it is important that prehospital care evolves to better understand the needs of older persons following trauma. 3 Therefore, the objectives of this study were to: (i) compare characteristics of older major trauma patients with those of younger patients; (ii) compare characteristics of older adult major trauma patients across three age groups; (iii) determine whether older patients are less likely to be transported to the TC than younger patients (directly or indirectly); and (iv) determine the association between non-major TC transport and inhospital mortality in older adults.…”

Section: Introductionmentioning

confidence: 99%

Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth

Brown

Tohira

Bailey

et al. 2019

Emerg Medicine Australasia

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Objective To describe the characteristics and outcomes of older adult (≥65 years) major trauma patients in comparison with younger adults (16–64 years). To determine whether older age is associated with a reduced likelihood of transport (directly or indirectly) to a major trauma centre and whether this is associated with in‐hospital mortality. Methods A retrospective cohort study of major trauma patients transported to hospital by St John Ambulance paramedics in Perth, Western Australia, between 1 January 2013 and 31 December 2016. Multivariate logistic regression was used to test the relationship between age and major trauma centre transport. Multivariate logistic regression analysis using inverse probability of treatment weighting was used to determine if major trauma centre transport was associated with in‐hospital mortality in older adults. Results One thousand six hundred and twenty‐five patients were included; of these 576 (35%) were ≥65 years. In comparison with younger adults, older adults had more falls as their mechanism of injury (n = 358 [62%] versus n = 102 [10%], P ≤ 0.001) and more major head injuries (n = 472 [82%] versus n = 609 [58%], P ≤ 0.001). Older adults had lower odds (adjusted odds ratio 0.52, 95% confidence interval [CI] 0.35–0.78) of major trauma centre transport and this was associated with 1.7 times the likelihood of in‐hospital mortality (95% CI 1.04–2.7). Conclusions Older adults who were not transported to the trauma centre had an increased odds of in‐hospital mortality. However, older age was associated with a significantly reduced likelihood of trauma centre transport. With the aging population, the development of specific prehospital triage criteria to enable the complexities of this higher‐risk population to be identified is important.

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Compliance to prehospital trauma triage protocols worldwide: A systematic review

Cited by 37 publications

References 47 publications

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth

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