Accuracy of Prehospital Triage in Selecting Severely Injured Trauma Patients

TLDR

Adequate prehospital triage is a major component of trauma care. The study prospectively evaluates the quality of the field triage system to identify severely injured adult trauma patients and optimize prehospital triage. The study matched prehospital EMS data to hospital trauma registry data for 4,950 adult patients, using an Injury Severity Score ≥ 16 to define severe injury and assessed protocol quality and compliance. The field triage protocol had a 21.6 % undertriage and 30.6 % overtriage rate overall, with a 63.8 % undertriage when evaluated by protocol criteria alone, 73 % compliance for level‑1 indications, and more than 20 % of severely injured patients not transported to a level‑I trauma center, underscoring the need for protocol improvement.

Abstract

A major component of trauma care is adequate prehospital triage. To optimize the prehospital triage system, it is essential to gain insight in the quality of prehospital triage of the entire trauma system.To prospectively evaluate the quality of the field triage system to identify severely injured adult trauma patients.Prehospital and hospital data of all adult trauma patients during 2012 to 2014 transported with the highest priority by emergency medical services professionals to 10 hospitals in Central Netherlands were prospectively collected. Prehospital data collected by the emergency medical services professionals were matched to hospital data collected in the trauma registry. An Injury Severity Score of 16 or more was used to determine severe injury.The quality and diagnostic accuracy of the field triage protocol and compliance of emergency medical services professionals to the protocol.A total of 4950 trauma patients were evaluated of which 436 (8.8%) patients were severely injured. The undertriage rate based on actual destination facility was 21.6% (95% CI, 18.0-25.7) with an overtriage rate of 30.6% (95% CI, 29.3-32.0). Analysis of the protocol itself, regardless of destination facility, resulted in an undertriage of 63.8% (95% CI, 59.2-68.1) and overtriage of 7.4% (95% CI, 6.7-8.2). The compliance to the field triage trauma protocol was 73% for patients with a level 1 indication.More than 20% of the patients with severe injuries were not transported to a level I trauma center. These patients are at risk for preventable morbidity and mortality. This finding indicates the need for improvement of the prehospital triage protocol.