Prehospital triage tools across the world: a scoping review of the published literature

Abstract

Background Accurate triage of the undifferentiated patient is a critical task in prehospital emergency care. However, there is a paucity of literature synthesizing currently available prehospital triage tools. This scoping review aims to identify published tools used for prehospital triage globally and describe their performance characteristics. Methods A comprehensive search was performed of primary literature in English-language journals from 2009 to 2019. Papers included focused on emergency medical services (EMS) triage of single patients. Two blinded reviewers and a third adjudicator performed independent title and abstract screening and subsequent full-text reviews. Results Of 1521 unique articles, 55 (3.6%) were included in the final synthesis. The majority of prehospital triage tools focused on stroke (n = 19; 35%), trauma (19; 35%), and general undifferentiated patients (15; 27%). All studies were performed in high income countries, with the majority in North America (23, 42%) and Europe (22, 40%). 4 (7%) articles focused on the pediatric population. General triage tools aggregate prehospital vital signs, mental status assessments, history, exam, and anticipated resource need, to categorize patients by level of acuity. Studies assessed the tools’ ability to accurately predict emergency department triage assignment, hospitalization and short-term mortality. Stroke triage tools promote rapid identification of patients with acute large vessel occlusion ischemic stroke to trigger timely transport to diagnostically- and therapeutically-capable hospitals. Studies evaluated tools’ diagnostic performance, impact on tissue plasminogen activator administration rates, and correlation with in-hospital stroke scales. Trauma triage tools identify patients that require immediate transport to trauma centers with emergency surgery capability. Studies evaluated tools’ prediction of trauma center need, under-triage and over-triage rates for major trauma, and survival to discharge. Conclusions The published literature on prehospital triage tools predominantly derive from high-income health systems and mostly focus on adult stroke and trauma populations. Most studies sought to further simplify existing triage tools without sacrificing triage accuracy, or assessed the predictive capability of the triage tool. There was no clear ‘gold-standard’ singular prehospital triage tool for acute undifferentiated patients. Trial registration Not applicable.

Field Triage Tools in Mass Casualty Incidents: A Narrative Review

“…During World War I, for instance, rudimentary triage methods were used to sort wounded soldiers based on the severity of their injuries and the likelihood of survival. Over time, these early triage concepts evolved into more structured protocols and algorithms designed to prioritize patients in emergency settings [9][10][11].…”

“…In subsequent decades, advancements in trauma care, emergency medicine, and disaster preparedness led to the refinement and adaptation of field triage tools to meet evolving challenges. New triage systems, such as JumpSTART for pediatric patients and the Sort, Assess, Lifesaving Interventions, Treat/Transport (SALT) method, were introduced to address specific population needs and improve triage accuracy [9,11].…”

“…In the 1980s, the concept of mass casualty triage gained prominence with the publication of guidelines by organizations like the American College of Surgeons (ACS) and the National Disaster Medical System (NDMS). These guidelines provided frameworks for triage decision-making and emphasized the importance of rapid assessment and resource allocation in MCIs [11,12].…”

Accuracy of Trauma on Scene Triage Screening Tool (Shock Index, Reverse Shock Index Glasgow Coma Scale and National Early Warning Score) to Predict the Severity of Emergency Department Triage: A Retrospective Cross-Sectional Study

“…However, the current study highlights that no single triage tool is universally regarded as the gold standard or most accurate for out-of-hospital screening, particularly in traumatic injuries. 3 To ensure optimal patient outcomes, a standardized emergency department (ED) screening tool should maintain a low level of undertriage (<5%) and over-triage (<35%). 4 Accurate out-of-hospital emergency triage tools play a critical role in developing countries where early-stage EMS systems require effective screening tools to determine the severity of trauma patients and facilitate their transport to the appropriate trauma care facility.…”

Implementation of the South African Triage Scale (SATS) in a New Ambulance System in Beira, Mozambique: A Retrospective Observational Study

“…In this scenario, the implementation of patient prioritisation strategies is pivotal in managing the challenges associated with the existing mismatch between the demand for emergency care and the available resources, thus avoiding the inappropriate use of national referral hospitals and all the consequences associated with it. While prehospital triage criteria for patient transport are frequently adopted in upper-middle- and high-income countries [ 8 ], there is a lack of the scientific literature on the implementation of triage systems in LMICs’ prehospital settings, and no consensus on which triage tool works better in these contexts exists [ 9 , 10 ]. More broadly, only recently have LMICs started incorporating triage tools into emergency department practice by either adapting existing protocols or implementing new tools such as the South African Triage Scale (SATS) [ 11 , 12 , 13 ].…”