Prehospital identification of major trauma patients

Ocak, Gürbey; Sturms, Leontien M.; Hoogeveen, Josephine M.; Cessie, Saskia le; Jukema, G. N.

doi:10.1007/s00423-008-0340-4

Cited by 22 publications

(10 citation statements)

References 26 publications

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“…Several retrospective studies have introduced new prehospital triage models to identify major trauma patients in the prehospital setting. However, these models still need to be validated in prospective studies [22]. …”

Section: Discussionmentioning

confidence: 99%

Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands

Giannakópoulos

Lubbers

Christiaans

et al. 2010

Langenbecks Arch Surg

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BackgroundThe trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched. The aim of this study was to assess the cancellation rate and the noncompliant dispatches of our MMT and to identify factors associated with this form of primary overtriage.MethodsBy retrospective analysis of all MMT dispatches in the period from 1 July 2006 till 31 December 2006 using chart review, we conducted a consecutive case review of 605 dispatches. Four hundred and sixty seven of these were included for our study, collecting data related to prehospital triage, patient’s condition on-scene and hospital course.ResultsAverage age was 35.9 years; the majority of the patients were male (65.3%). Four hundred and thirty patients were victims of trauma, sustaining injuries in most cases from blunt trauma (89.3%). After being dispatched, the MMT was cancelled 203 times (43.5%). Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p < 0.001). All dispatches were evaluated by using the MMT-dispatch criteria and mission appropriateness criteria. Almost 26% of all dispatches were neither appropriate, nor met the dispatch criteria. Fourteen missions were appropriate, but did not meet the dispatch criteria. The remaining 318 dispatches had met the dispatch criteria, of which 135 (30.3%) were also appropriate. The calculated additional costs of the cancelled dispatches summed up to a total of € 34,448, amounting to 2.2% of the total MMT costs during the study period.ConclusionIn our trauma system, the MMT dispatches are involved with high rates of overtriage. After being dispatched, the MMT is cancelled in almost 50% of all cases. We found an undertriage rate of 4%, which we think is acceptable. All cancellations were justified. The additional costs of the cancelled missions were within an acceptable range. According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to non-acceptable levels.

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Section: Discussionmentioning

confidence: 99%

Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands

Giannakópoulos

Lubbers

Christiaans

et al. 2010

Langenbecks Arch Surg

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“…Previous studies have shown a lower compliance rate to the vital sign criteria [23,34,38]. This could be because the majority of the trauma patients have normal or near normal vital signs [39][40][41].…”

Section: Discussionmentioning

confidence: 99%

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

Rein

Sadiqi

Lansink

et al. 2018

Eur J Trauma Emerg Surg

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Purpose Severely injured patients should be treated at higher-level trauma centres, to improve chances of survival and avert life-long disabilities. Emergency medical service (EMS) providers must try to determine injury severity on-scene, using a prehospital trauma triage protocol, and decide the most appropriate type of trauma centre. The objective of this study is to investigate the role of EMS provider judgment in the prehospital triage process of trauma patients, by analysing the compliance rate to the protocol and administering a questionnaire among EMS providers. Methods All trauma patients transported to a trauma centre in two different regions of the Netherlands were analysed. Compliance rate was based on the number of patients meeting the triage criteria and transported to the corresponding level trauma centre. The questionnaire was administered among EMS providers. Descriptive statistics were used to analyse the data. Results For adult patients, the compliance rate to the level I criteria of the triage protocol was 72% in Central Netherlands and 42% in Brabant. For paediatric patients, this was 63% and 38% in Central Netherlands and Brabant, respectively. The judgment on injury severity was mostly based on the injury-type criteria. Additionally, the distance to a level I trauma centre influenced the decision for destination facility in the Brabant region. Conclusion The compliance rate varied between regions. Improvement of prehospital trauma triage depends on the accuracy of the protocol and compliance rate. A new protocol, including EMS provider judgment, might be the key to improvement in the prehospital trauma triage quality.

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“…En el caso de la atención del paciente en el campo prehospitalario, se han desarrollado varios criterios de triage para determinar la severidad de las lesiones, el modo de transporte y el destino más apropiado para un paciente de trauma. [21][22][23] En este campo el índice de shock ha sido propuesto como un criterio en el Protocolo Nacional de Triage en Trauma en los Estados Unidos para direccionar al el paciente a un Centro de Trauma, mostrando que un valor >1.0 aumenta la sensibilidad con una mínima reducción de la especificidad comparado con una tensión arterial sistólica <90mmHg para identificar a los pacientes inestables que requieren atención de mayor complejidad.…”

Section: Discussionunclassified

Indice de Shock: ¿Puede Predecir La Necesidad de Cirugia de Conrol de Daños En Trauma Penetrante?

Ordóñez¹,

Orozco²,

Puyana³

et al. 2017

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Introducción:Valores elevados del Índice de Shock (IS) se han asociado con un incremento en la mortalidad y con la necesidad de requerimiento de transfusiones masivas en pacientes traumatizados, pero su habilidad para identificar pacientes que requieran Cirugía de Control de Daños (CCD) es desconocida. El objetivo de este estudio fue identifica un punto de corte del IS para predecir necesidad de CCD en pacientes con trauma penetrante. Materials y métodos:Estudio retrospectivo por un periodo de 10 años que incluyo todos los pacientes adultos que ingresaron por trauma penetrante de torso a un Centro de Trauma de referencia. El IS fue calculado al ingreso y los pacientes se dividieron en los que necesitaron CCD y los que no (No-CCD). Para determinar la exactitud del IS identificando pacientes que requirieron CCD se calculo el Área Bajo la Curva ROC (AUROC) del 95%. Conclusión: El IS puede ser en cierto grado indicativo de la necesidad de CCD en los pacientes con trauma penetrante de torso, sin embargo un punto específico de corte para predecir CCD no fue estadísticamente encontrado. Source of support: Nil Conflict of interest: None ABSTRACT Introduction:The objective of our study was to identify a possible shock index (SI) cutoff number that could reliable predicts the need for damage control surgery (DCS) in penetrating trauma patients. Materials and methods:A retrospective 10-year study (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) which included all adult patients that suffered penetrating torso trauma at a level I trauma center. The SI was calculated upon admission and patients were divided into two groups: those that required DCS and those that did not (No-DCS). A 95% confidence interval for the area under a receiver operating characteristic curve (AUROC) was used to determine the accuracy of SI in detecting patients that would require DCS.Results: A total of 747 patients were included, 92.3% were male and 80% suffered gunshot wounds. The DCS group had a total of 331 (44%) Conclusions:We have shown that SI can be indicative to some degree of the need for DCS in patients suffering penetrating torso trauma but a specific cutoff point that can precisely predict this need is statically unobtainable.

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Prehospital identification of major trauma patients

Cited by 22 publications

References 26 publications

Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands

Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

Indice de Shock: ¿Puede Predecir La Necesidad de Cirugia de Conrol de Daños En Trauma Penetrante?

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