Prehospital identification of major trauma patients.

BACKGROUND AND AIMS: Prehospital triage is aimed at getting the right patient to the right hospital. Evaluations on the performance of prehospital triage tools are scarce. This study examines the ability of the American College of Surgeons' Committee on Trauma (ACSCOT) triage guidelines to identify major trauma patients in a European trauma system. Furthermore, this study evaluates the predictive power of other prehospital measurements. MATERIALS AND METHODS: Prehospital data of 151 minor (Injury Severity Score (ISS) 1-15) and 151 major trauma patients, (ISS > 15) treated at a Dutch trauma center, were collected. Logistic regression analysis was used to identify predictors of major trauma patients. RESULTS: The major trauma patients particularly incurred severe head injuries (45.7%) and severe thorax injuries (21.9%). The ACSCOT guidelines had a sensitivity of 84.1% and a specificity of 77.5%. A new prehospital trauma triage model was constructed including nine predictors of major trauma. This model identified more major trauma patients than the ACSCOT (sensitivity 92.1%, p = 0.023) and resulted in a comparable specificity (79.5%; p = 0.711). CONCLUSION: The new triage model outperforms the ACSCOT triage guidelines in identifying major trauma patients in the prehospital setting. The new triage guidelines may improve patient outcomes but needs to be validated in a prospective study.

Prehospital triage and survival of major trauma patients in a Dutch regional trauma system: relevance of trauma registry.

BACKGROUND AND AIMS: Since 1999, the Dutch trauma care has been regionalized into ten trauma systems. This study is the first to review such a trauma system. The aim was to examine the sensitivity of prehospital triage criteria [triage revised trauma score (T-RTS)] in identifying major trauma patients and to evaluate the current level of trauma care of a regionalized Dutch trauma system for major trauma patients. PATIENTS AND METHODS: Major trauma patients (n=511) (June 2001-December 2003) were selected from a regional trauma registry database. The prehospital T-RTS was computed and standardized W scores (Ws) were generated to compare observed vs expected survival based on contemporary US- and UK-norm databases. RESULTS: The T-RTS showed low sensitivity for the prehospital identification of major trauma patients [34.1% (T-RTS< or =10)]. Nevertheless, 78.0% of all major trauma patients were directly managed by the trauma center. These patients were more severely injured than their counterparts at non-trauma-center hospitals (p<0.001). No significant difference emerged between the mortality rates of both groups. The Ws {-0.46 calculated on the US model [95% confidence interval (CI) ranging from -1.99 to 1.07]} [0.60 calculated on the UK model (95% CI ranging from -1.25 to 2.44)] did not differ significantly from zero. CONCLUSION: The trauma center managed most of the major trauma patients in the trauma system but the triage criteria need to be reconsidered. The level of care of the regional trauma system was shown to measure up to US and UK benchmarks.