Accuracy of Prehospital Triage in Selecting Severely Injured Trauma Patients

Voskens, Frank J.; Rein, Eveline A. J. van; Sluijs, Rogier van der; Houwert, Roderick M.; Lichtveld, Rob A.; Verleisdonk, E. J. M. M.; Segers, Michiel J. M.; Olden, Ger van; Dijkgraaf, Marcel G. W.; Leenen, Luke P. H.; Heijl, Mark van

doi:10.1001/jamasurg.2017.4472

Cited by 111 publications

(110 citation statements)

References 24 publications

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“…Validity studies are lacking for the RETTS-p but previous studies have shown a good to a very good reliability between nurses in the pED [ 15 , 16 ]. The accuracy of triage in the EMS has been extensively studied in the assessment of trauma patients, indicating difficulties in the assessment of the patient with both over-triage and under-triage [ 17 – 20 ]. A five-level triage tool in the EMS might be favourable for detecting a severely ill patient [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

Magnusson

Herlitz

Karlsson

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundThe assessment of children in the Emergency Medical Service (EMS) is infrequent representing 5.4% of the patients in an urban area in the western part of Sweden. In Sweden, patients are assessed on scene by an EMS nurse whom independently decides on interventions and level of care. To aid the EMS nurse in the assessment a triage instrument, Rapid Emergency Triage and Treatment System-paediatrics (RETTS-p) developed for Emergency Department (ED) purpose has been in use the last 5 years. The aim of this study was to evaluate the EMS nurse assessment, management, the utilisation of RETTS-p and patient outcome.MethodsA prospective, observational study was performed on 651 children aged < 16 years from January to December 2016. Statistical tests used in the study were Mann-Whitney U test, Fisher’s exact test and Spearman’s rank statistics.ResultsThe dispatch centre indexed life-threatening priority in 69% of the missions but, of all children, only 6.1% were given a life threatening RETTS-p red colour by the EMS nurse. A total of 69.7% of the children were transported to the ED and, of these, 31.7% were discharged without any interventions. Among the non-conveyed patients, 16 of 197 (8.1%) visited the ED within 72 h but only two were hospitalised. Full triage, including five out of five vital signs measurements and an emergency severity index, was conducted in 37.6% of all children. A triage colour was not present in 146 children (22.4%), of which the majority were non-conveyed. The overall 30-day mortality rate was 0.8% (n = 5) in children 0–15 years.ConclusionsDespite the incomplete use of all vital signs according to the RETTS-p, the EMS nurse assessment of children appears to be adapted to the clinical situation in most cases and the patients appear to be assessed to the appropriate level of care but indicating an over triage. It seems that the RETTS-p with full triage is used selectively in the pre-hospital assessment of children with a risk of death during the first 30 days of less than 1%.

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Section: Introductionmentioning

confidence: 99%

Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

Magnusson

Herlitz

Karlsson

et al. 2018

Scand J Trauma Resusc Emerg Med

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“…Triage criteria are less sensitive for paediatric patients; however, the EMS are more easily inclined to transport a paediatric patient to a level I trauma centre, compared to adult patients [24]. The elderly patients, on the other hand, are notoriously undertriaged [13,19,34,36,37]. Injuries in elderly patients are increasing in frequency, are difficult to recognise-due to a difference in mechanism of injury and masked physiologic derangement-and carry a higher mortality rate compared to the young [22].…”

Section: Discussionmentioning

confidence: 99%

“…Also, the ISS was only available for the patients who were admitted or who deceased before admission, in the Brabant region. A previous study showed all the severely injured patients (ISS > 15) were admitted or deceased before admission [19]. Accordingly, for Brabant, it was assumed that all the patients discharged from the ED had an ISS < 15.…”

Section: Discussionmentioning

confidence: 99%

“…Fig. 1 The national field triage protocol of the Netherlands ISS < 15 was assumed for patients discharged from the ED, as it has previously been shown all discharged patients had an ISS < 15 in Central Netherlands [19]. The Revised Trauma Score [20] was based on the multiply imputed Glasgow Coma Scale, systolic blood pressure and respiratory rate for both regions.…”

Section: Whole Protocol =mentioning

confidence: 99%

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The role of emergency medical service providers in the decision-making process of prehospital trauma triage

Rein

Sadiqi

Lansink

et al. 2018

Eur J Trauma Emerg Surg

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Purpose Severely injured patients should be treated at higher-level trauma centres, to improve chances of survival and avert life-long disabilities. Emergency medical service (EMS) providers must try to determine injury severity on-scene, using a prehospital trauma triage protocol, and decide the most appropriate type of trauma centre. The objective of this study is to investigate the role of EMS provider judgment in the prehospital triage process of trauma patients, by analysing the compliance rate to the protocol and administering a questionnaire among EMS providers. Methods All trauma patients transported to a trauma centre in two different regions of the Netherlands were analysed. Compliance rate was based on the number of patients meeting the triage criteria and transported to the corresponding level trauma centre. The questionnaire was administered among EMS providers. Descriptive statistics were used to analyse the data. Results For adult patients, the compliance rate to the level I criteria of the triage protocol was 72% in Central Netherlands and 42% in Brabant. For paediatric patients, this was 63% and 38% in Central Netherlands and Brabant, respectively. The judgment on injury severity was mostly based on the injury-type criteria. Additionally, the distance to a level I trauma centre influenced the decision for destination facility in the Brabant region. Conclusion The compliance rate varied between regions. Improvement of prehospital trauma triage depends on the accuracy of the protocol and compliance rate. A new protocol, including EMS provider judgment, might be the key to improvement in the prehospital trauma triage quality.

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“…Previous studies show that many patients with severe head trauma are not transported to a higher-level trauma centre [9][10][11][12][13]. The ability of EMS providers to accurately identify patients with a head injury is Correspondence unknown.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of emergency medical services provider judgement in the identification of head injuries among trauma patients

Rein¹,

Jochems²,

Lokerman³

et al. 2018

Euro J of Neurology

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Accuracy of Prehospital Triage in Selecting Severely Injured Trauma Patients

Abstract: 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.

Cited by 111 publications

References 24 publications

Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

Diagnostic value of emergency medical services provider judgement in the identification of head injuries among trauma patients

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