Accuracy and influencing factors of the Field Triage Decision Scheme for adult trauma patients at a level-1 trauma center in Korea

Abstract

Background We evaluated the accuracy of the prehospital Field Triage Decision Scheme, which has recently been applied in the Korean trauma system, and the factors associated with severe injury and prognosis at a regional trauma center in Korea. Methods From 2016 to 2018, prehospital data of injured patients were obtained from the emergency medical services of the national fire agency and matched with trauma outcomes at our institution. Severe injury (Injury Severity Score > 15), overtriage/undertriage rate, positive predictive value, negative predictive value, and accuracy were reviewed according to the triage protocol steps. A multivariate logistic regression analysis was performed to identify influencing factors in the field triage. Results Of the 2438 patients reviewed, 853 (35.0%) were severely injured. The protocol accuracy was as follows: step 1, 72.3%; step 2, 65.0%; step 3, 66.2%; step 1 or 2, 70.2%; and step 1, 2, or 3, 66.4%. Odds ratios (OR) (95% confidence interval [CIfor systolic blood pressure < 90 mmHg (3.535 [1.920–6.509]; p < 0.001), altered mental status (17.924 [8.980–35.777]; p < 0.001), and pedestrian injuries (2.473 [1.339–4.570], p = 0.04) were significantly associated with 24-h mortality. Penetrating torso injuries (7.108 [4.108–12.300]; p < 0.001); two or more proximal long bone fractures (4.134 [2.316–7.377]); p < 0.001); crushed, degloved, and mangled extremities (8.477 [4.068–17.663]; p < 0.001); amputation proximal to the wrist or ankle (42.964 [5.764–320.278]; p < 0.001); and fall from height (2.141 [1.497–3.062]; p < 0.001) were associated with 24-h surgical intervention. Conclusion The Korean field triage protocol is not yet accurate, with only some factors reflecting injury severity, making reevaluation necessary.

Right patient to the right place: the impact of a 6-year regional trauma center-led prehospital trauma education program on patient outcomes

“…The selection of hospitals for transporting patients with trauma by EMS providers is in uenced by various factors such as geographical proximity to hospitals, preference of patients and families, experience of paramedics, and level of the regional trauma system [22,29,31]. In Korea, in which the government-led regional trauma center establishment project was started in 2012, there were differences in preventable mortality according to the triage and transport of patients with trauma between regions and between cities and rural areas in 2023.…”

“…However, correct triage of patients with severe trauma in the prehospital stage proves di cult, and their treatment experience depends on the accuracy of trauma triage [12][13][14][15]. Therefore, to improve trauma triage, a regional trauma center-led training program for EMS providers, remote medical guidance by experienced trauma staff, and new triage criteria for trauma patients have been proposed [16][17][18][19][20][21][22]. However, EMS providers lack awareness regarding the Korean trauma center, which has been operational since 2014, and there has been no specialized training for paramedics on the triage of patients with severe trauma or the selection of transfer hospitals.…”

Prognostic Association between Injury Severity Score and the Outcomes of Elderly Patients with Trauma in South Korea

“…One crucial aspect of prognostication in trauma care is the evaluation of injury severity. Injury Severity Scores (ISSs) are widely used to quantify the severity of traumatic injuries and provide standardized measures for risk stratification and prognostication [7]. A high ISS is generally associated with more severe injuries, higher mortality rates, and worse clinical outcomes.…”

“…Consequently, this population tends toward either in-hospital mortality or discharge with an optimistic prognostication of functional recovery [5,6]. However, it remains unclear how ISS and other prognostic factors differ in their predictive value when applied specifically to elderly patients with trauma vs. their non-elderly counterparts [7].…”

Right patient to the right place: The impact of a 6-year regional trauma centre-led prehospital education program on EMS triage and patient outcomes

“…However, accurate triage of patients with severe trauma in the prehospital setting remains challenging [10][11][12][13]. Therefore, to improve trauma triage, a regional trauma centre-led training program for EMS providers, remote medical guidance by experienced trauma staff, and new triage criteria for patients with trauma have been proposed [14][15][16][17][18][19][20]. However, EMS providers insu ciently informed about the Korean trauma centre, established since 2014, and there has been no specialised training for paramedics regarding the triage of patients with severe trauma or the selection of transfer hospitals.…”