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

Abstract

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.

The Suitability of the CdC field Triage for Korean Trauma Care

“…Fig. 2 shows how physiologic factors contributed the most to the performance of the CDC triage system in this study, which is consistent with the results of previous research [11,12]. Physiologic categories are also one of the most important factors in determining the severity of trauma.…”

Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit

“…One study [ 32 ] was included only in qualitative analysis since it investigated the performance of each category of the Vittel Criteria Algorithm (VCA) in predicting the risk of an ISS > 15, mortality within 30 days, or admission to Intensive Care Unit ( N = 2 764): 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. However, this study did not provide overall sn and sp values needed for quantitative analyses.…”

Herding cats: ethics in prehospital triage

“…Numerous triage models have been established for the purpose of rapidly sorting and categorizing of victims for prehospital settings [8,[60][61][62][63][64]. Though, there is insufficient evidence showing which prehospital triage systems/models are effective in achieving better health outcomes and quality of care [5,57,[65][66][67][68][69].…”