Priority accuracy by dispatch centers and Emergency Medical Services professionals in trauma patients: a cohort study

Waalwijk, Job F; Lokerman, Robin D; Sluijs, Rogier van der; Fiddelers, Audrey A. A.; Leenen, Luke P. H.; Heijl, Mark van; Poeze, Martijn

doi:10.1007/s00068-021-01685-1

Cited by 4 publications

(1 citation statement)

References 20 publications

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“… 17 , 18 Confounders were chosen based on clinical reasoning and previous literature. 8 , 11 , 19 , 20 , 21 Risks and odds were adjusted for age, sex, dispatch priority, day of the week, hour of the day, distance to the nearest higher-level trauma center, penetrating injury, hemodynamic instability (ie, compromised airway, breathing, or circulation), prehospital vital signs (systolic blood pressure, respiratory rate, Glasgow Coma Scale score, heart rate, and oxygen saturation), and ISS. Restricted cubic splines with 3 knots were used to account for nonlinearity.…”

Section: Methodsmentioning

confidence: 99%

Accuracy of Prehospital Triage of Adult Patients With Traumatic Injuries Following Implementation of a Trauma Triage Intervention

et al. 2023

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ImportanceAdequate prehospital triage is pivotal to enable optimal care in inclusive trauma systems and reduce avoidable mortality, lifelong disabilities, and costs. A model has been developed to improve the prehospital allocation of patients with traumatic injuries and was incorporated in an application (app) to be implemented in prehospital practice.ObjectiveTo evaluate the association between the implementation of a trauma triage (TT) intervention with an app and prehospital mistriage among adult trauma patients.Design, Setting, and ParticipantsThis population-based, prospective quality improvement study was conducted in 3 of the 11 Dutch trauma regions (27.3%), with full coverage of the corresponding emergency medical services (EMS) regions participating in this study. Participants included adult patients (age ≥16 years) with traumatic injuries who were transported by ambulance between February 1, 2015, and October 31, 2019, from the scene of injury to any emergency department in the participating trauma regions. Data were analyzed between July 2020 and June 2021.ExposuresImplementation of the TT app and the awareness of need for adequate triage created by its implementation (ie, the TT intervention).Main Outcomes and MeasuresThe primary outcome was prehospital mistriage, evaluated in terms of undertriage and overtriage. Undertriage was defined as the proportion of patients with an Injury Severity Score (ISS) of 16 or greater who were initially transported to a lower-level trauma center (designated to treat patients who are mildly and moderately injured) and overtriage as the proportion of patients with an ISS of less than 16 who were initially transported to a higher-level trauma center (designated to treat patients who are severely injured).ResultsA total of 80 738 patients were included (40 427 [50.1%] before and 40 311 [49.9%] after implementation of the intervention), with a median (IQR) age of 63.2 (40.0-79.7) years and 40 132 (49.7%) male patients. Undertriage decreased from 370 of 1163 patients (31.8%) to 267 of 995 patients (26.8%), while overtriage rates did not increase (8202 of 39 264 patients [20.9%] vs 8039 of 39 316 patients [20.4%]). The implementation of the intervention was associated with a statistically significantly reduced risk for undertriage (crude risk ratio [RR], 0.95; 95% CI, 0.92 to 0.99, P = .01; adjusted RR, 0.85; 95% CI, 0.76-0.95; P = .004), but the risk for overtriage was unchanged (crude RR, 1.00; 95% CI, 0.99-1.00; P = .13; adjusted RR, 1.01; 95% CI, 0.98-1.03; P = .49).Conclusions and RelevanceIn this quality improvement study, implementation of the TT intervention was associated with improvements in rates of undertriage. Further research is needed to assess whether these findings are generalizable to other trauma systems.

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Section: Methodsmentioning

confidence: 99%

Accuracy of Prehospital Triage of Adult Patients With Traumatic Injuries Following Implementation of a Trauma Triage Intervention

et al. 2023

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Merging of two level-1 trauma centers in Amsterdam: premerger demand in integrated acute trauma care

Berkeveld

Zuidema

Azijli

et al. 2023

Eur J Trauma Emerg Surg

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Purpose Availability of adequate and appropriate trauma care is essential. A merger of two Dutch academic level-1 trauma centers is upcoming. However, in the literature, volume effects after a merger are inconclusive. This study aimed to examine the premerger demand for level-1 trauma care on integrated acute trauma care and evaluate the expected demand on the system. Methods A retrospective observational study was conducted between 1-1-2018 and 1-1-2019 in two level-1 trauma centers in the Amsterdam region using data derived from the local trauma registries and electronic patient records. All trauma patients presented at both centers’ Emergency Departments (ED) were included. Patient- and injury characteristics and data concerning all prehospital and in-hospital-delivered trauma care were collected and compared. Pragmatically, the demand for trauma care in the post-merger setting was considered a sum of care demand for both centers. Results In total, 8277 trauma patients were presented at both EDs, 4996 (60.4%) at location A and 3281 (39.6%) at location B. Overall, 462 patients were considered severely injured patients (Injury Severity Score ≥ 16). In total, 702 emergency surgeries (< 24 h) were performed, and 442 patients were admitted to the ICU. The sum care demand of both centers resulted in a 167.4% increase in trauma patients and a 151.1% increase in severely injured patients. Moreover, on 96 occasions annually, two or more patients within the same hour would require advanced trauma resuscitation by a specialized team or emergency surgery. Conclusion A merger of two Dutch level-1 trauma centers would, in this scenario, result in a more than 150% increase in the post-merger setting’s demand for integrated acute trauma care.

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Artificial intelligence in emergency medicine. A systematic literature review

Piliuk,

Tomforde

2023

International Journal of Medical Informatics

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Priority accuracy by dispatch centers and Emergency Medical Services professionals in trauma patients: a cohort study

Cited by 4 publications

References 20 publications

Accuracy of Prehospital Triage of Adult Patients With Traumatic Injuries Following Implementation of a Trauma Triage Intervention

Accuracy of Prehospital Triage of Adult Patients With Traumatic Injuries Following Implementation of a Trauma Triage Intervention

Merging of two level-1 trauma centers in Amsterdam: premerger demand in integrated acute trauma care

Artificial intelligence in emergency medicine. A systematic literature review

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