Prehospital transportation decisions for patients sustaining major trauma in road traffic crashes in Sweden

Candefjord, Stefan; Buendia, Ruben; Caragounis, Eva Corina; Sjöqvist, Bengt Arne; Fagerlind, Helen

doi:10.1080/15389588.2016.1198872

Cited by 20 publications

(15 citation statements)

References 12 publications

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“…In this region, the nearest hospital is often a level II or III trauma centre; transport of severely injured patients to these trauma centres results in an increase in undertriage. Previous studies reported a lowered likelihood of transport to a higher level trauma centre with increased geographical distance [25][26][27].…”

Section: Discussionmentioning

confidence: 94%

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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Section: Discussionmentioning

confidence: 94%

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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“…3,19 Studies show that it is common that a large proportion of patients with major trauma are first transported to non-trauma centers. 3,18,20 …”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of a Microwave-Based Device for Detection of Traumatic Intracranial Hemorrhage

Ljungqvist

Candefjord

Persson

et al. 2017

Journal of Neurotrauma

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Traumatic brain injury (TBI) is the leading cause of death and disability among young persons. A key to improve outcome for patients with TBI is to reduce the time from injury to definitive care by achieving high triage accuracy. Microwave technology (MWT) allows for a portable device to be used in the pre-hospital setting for detection of intracranial hematomas at the scene of injury, thereby enhancing early triage and allowing for more adequate early care. MWT has previously been evaluated for medical applications including the ability to differentiate between hemorrhagic and ischemic stroke. The purpose of this study was to test whether MWT in conjunction with a diagnostic mathematical algorithm could be used as a medical screening tool to differentiate patients with traumatic intracranial hematomas, chronic subdural hematomas (cSDH), from a healthy control (HC) group. Twenty patients with cSDH and 20 HC were measured with a MWT device. The accuracy of the diagnostic algorithm was assessed using a leave-one-out analysis. At 100% sensitivity, the specificity was 75%—i.e., all hematomas were detected at the cost of 25% false positives (patients who would be overtriaged). Considering the need for methods to identify patients with intracranial hematomas in the pre-hospital setting, MWT shows promise as a tool to improve triage accuracy. Further studies are under way to evaluate MWT in patients with other intracranial hemorrhages.

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“…However, the minimum requirement for Level I caseload is not met by any TC, why the designated TC’s are considered to be Level I-II. All other hospitals have lower capacity than Level II and were designated as emergency departments (ED) similar to a previous study [16]. TC’s and ED’s were included if they reported to STRADA throughout the selected time period, resulting in seven TC’s and 54 ED’s.…”

Section: Methodsmentioning

confidence: 99%

“…One hypothesis was that inability to identify the full extent of the trauma in the field may contribute to the apparent high undertriage. Another hypothesis was that the distance from the crash to the nearest trauma centre is a major contributor to the transport decision [16]. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics.…”

Section: Introductionmentioning

confidence: 99%

“…In a previous study from Sweden it was found that 62% of major trauma patients from road crashes were not directly transported to a TC [16], and thus the undertriage rate appears to far exceed the 5% benchmark suggested. One hypothesis was that inability to identify the full extent of the trauma in the field may contribute to the apparent high undertriage.…”

Section: Introductionmentioning

confidence: 99%

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Does injury pattern among major road trauma patients influence prehospital transport decisions regardless of the distance to the nearest trauma centre? – a retrospective study

Fagerlind

Harvey

Candefjord

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background Prehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that the pattern of injuries exceeding a certain severity threshold is not easily recognizable in the field. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics. Methods The Swedish Traffic Accident Data Acquisition (STRADA) database was queried from April 2011 to March 2017. Teaching hospitals with neurosurgery capabilities were classified as trauma centres (TC), all other hospitals were classified as other emergency departments (ED). Injury Severity Score ≥ 13 was used as the threshold for major trauma. Ten common injury patterns were derived from the STRADA data; six patterns included serious neuro trauma to the head or spine. The remaining four patterns were: other severe injuries, moderate to serious abdomen injuries, serious thorax injuries and all other remaining injury patterns. Logistic regression was used to analyse the effect of injury patterns, age, sex and distance from crash to nearest TC on transport decision (TC or ED). Results Of the 2542 patients, 38.0% were transported to a TC, equating to a prehospital undertriage of 62%. Over half (59.4%) of the patients had four or more Abbreviated Injury Scale (AIS) 2+ injuries. After controlling for age, sex and distance to nearest TC, only patients sustaining serious head injuries together with other severe injuries had significantly higher odds of being transported to a TC (OR = 4.18, 95% CI: 2.03, 8.73). The odds of being transported to a TC decreased by 5% with every kilometre further away the crash location was to the nearest TC. Conclusion These results highlight that there is considerable prehospital undertriage in Sweden and suggest that distance to nearest TC is more influential in transport decisions than injury pattern. These results can be used to further develop prehospital transportation guidelines and designation of trauma centres.

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Prehospital transportation decisions for patients sustaining major trauma in road traffic crashes in Sweden

Abstract: Our results show that the majority of RTC major trauma patients are transported to a non-TC. This may cause unnecessary morbidity and mortality. These findings can guide the development of improved prehospital treatment guidelines, protocols and decision support systems.

Cited by 20 publications

References 12 publications

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

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

Clinical Evaluation of a Microwave-Based Device for Detection of Traumatic Intracranial Hemorrhage

Does injury pattern among major road trauma patients influence prehospital transport decisions regardless of the distance to the nearest trauma centre? – a retrospective study

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