Effectiveness of prehospital trauma triage systems in selecting severely injured patients: Is comparative analysis possible?

Rein, Eveline A. J. van; Sluijs, Rogier van der; Houwert, Roderick M.; Gunning, Amy C.; Lichtveld, Rob A.; Leenen, Luke P. H.; Heijl, Mark van

doi:10.1016/j.ajem.2018.01.055

Cited by 52 publications

(44 citation statements)

References 69 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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: 56%

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.

View full text Add to dashboard Cite

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).

show abstract

Section: Discussionmentioning

confidence: 56%

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.

View full text Add to dashboard Cite

show abstract

“…A systematic review on the effectiveness of prehospital trauma triage systems revealed that a significant number of the severely injured patients were not transported to the appropriate level of trauma center. 16 The present study aims to explore the influence of prehospital times on mortality among patients with different trauma triage criteria.…”

Section: Introductionmentioning

confidence: 99%

Prehospital Intervals and In-Hospital Trauma Mortality: A Retrospective Study from a Level I Trauma Center

Al-Thani

Mekkodathil

Hertelendy

et al. 2020

Prehosp. Disaster med.

View full text Add to dashboard Cite

Background: The increase in mortality and total prehospital time (TPT) seen in Qatar appear to be realistic. However, existing reports on the influence of TPT on mortality in trauma patients are conflicting. This study aimed to explore the impact of prehospital time on the in-hospital outcomes. Methods: A retrospective analysis of data on patients transferred alive by Emergency Medical Services (EMS) and admitted to Hamad Trauma Center (HTC) of Hamad General Hospital (HGH; Doha, Qatar) from June 2017 through May 2018 was conducted. This study was centered on the National Trauma Registry database. Patients were categorized based on the trauma triage activation and prehospital intervals, and comparative analysis was performed. Results: A total of 1,455 patients were included, of which nearly one-quarter of patients required urgent and life-saving care at a trauma center (T1 activations). The overall TPT was 70 minutes and the on-scene time (OST) was 24 minutes. When compared to T2 activations, T1 patients were more likely to have been involved in road traffic injuries (RTIs); experienced head and chest injuries; presented with higher Injury Severity Score (ISS: median = 22); and had prolonged OST (27 minutes) and reduced TPT (65 minutes; P = .001). Prolonged OST was found to be associated with higher mortality in T1 patients, whereas TPT was not associated. Conclusions: In-hospital mortality was independent of TPT but associated with longer OST in severely injured patients. The survival benefit may extend beyond the golden hour and may depend on the injury characteristics, prehospital, and in-hospital settings.

show abstract

“…This result is above the recommendations of less than 5% as set by the ACSCOT (3). Many European and American studies reported similar or even higher undertriage rate (4,14,15,16). In a comparable health system also bene ting from physician on scene and medical dispatching, French authors reported higher undertriage rate about 18% (7 (17).…”

Section: Discussionmentioning

confidence: 91%

Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry

Benhamed

FRATICELLI²,

CLAUSTRE³

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundThe proper prehospital triage and transportation of patients suffering major trauma to lever 1 trauma centers is associated with better outcomes. Hence, emergency medical systems (EMS) aim is to avoid undertriage in these patients. The main objective of this study was to assess the rate and predictors of undertriage in a physician-led prehospital system.MethodsWe conducted an observational multicentric, region-wide, retrospective study based on the RESUVal Trauma-System registry, Rhône-Alpes region, France. All adults assessed by physician-led EMS units, from January 2011 to December 2017 with major trauma (Injury Severity Score (ISS) ≥ 16) were included. We defined the correct-triage group as major trauma patients admitted to a level I trauma center. We performed univariate then multivariate logistic regressions with undertriage as outcome.ResultsA total of 7,110 patients were included in the registry, of whom 2,591 patients with an ISS≥ 16. Among these patients, 320 (12.35%) were undertriaged. Median ISS was 25. In-hospital mortality was 16.45% (n=351/2134). Mid-aged patients (51-65 years old) were associated with a higher risk of undertriage than the others (OR=1.62, 95%CI 1.15-2.28, p=0.01). Factors associated with a lower risk of undertriage were: mechanism (fall or gunshot/stabbing wounds, 0.62, [0.45-0.86], p=0.01 and 0.44, [0.22-0.9], p=0.02, respectively), time on-scene (over 60 minutes, 0.61, [0.38-0.95], p=0.03), prehospital need for endotracheal intubation and ultrasound examination (0.53, [0.39-0.72], p<0.001 and 0.15, [0.08-0.29], p<0.001 respectively). After adjusting for severity, undertriage showed a non-significant tendency toward an increased risk of mortality (1.22, [0.8-1.89], p=0.36).ConclusionsIn our region-wide, physician-led prehospital system, undertriage of major trauma was not rare. The typical profile of undertriaged patients was a mid-aged male suffering from a blunt trauma, without respiratory distress or neurologic impairment, not benefiting from prehospital ultrasound examination and located close to a non-trauma center hospital.

show abstract

Effectiveness of prehospital trauma triage systems in selecting severely injured patients: Is comparative analysis possible?

Cited by 52 publications

References 69 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

Prehospital Intervals and In-Hospital Trauma Mortality: A Retrospective Study from a Level I Trauma Center

Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry

Contact Info

Product

Resources

About