Comparison of emergency department trauma triage performance of clinicians and clinical prediction models: a cohort study in India

Abstract

ObjectiveThe aim of this study was to evaluate and compare the abilities of clinicians and clinical prediction models to accurately triage emergency department (ED) trauma patients. We compared the decisions made by clinicians with the Revised Trauma Score (RTS), the Glasgow Coma Scale, Age and Systolic Blood Pressure (GAP) score, the Kampala Trauma Score (KTS) and the Gerdin et al model.DesignProspective cohort study.SettingThree hospitals in urban India.ParticipantsIn total, 7697 adult patients who presented to participating hospitals with a history of trauma were approached for enrolment. The final study sample included 5155 patients. The majority (4023, 78.0%) were male.Main outcome measureThe patient outcome was mortality within 30 days of arrival at the participating hospital. A grid search was used to identify model cut-off values. Clinicians and categorised models were evaluated and compared using the area under the receiver operating characteristics curve (AUROCC) and net reclassification improvement in non-survivors (NRI+) and survivors (NRI−) separately.ResultsThe differences in AUROCC between each categorised model and the clinicians were 0.016 (95% CI −0.014 to 0.045) for RTS, 0.019 (95% CI −0.007 to 0.058) for GAP, 0.054 (95% CI 0.033 to 0.077) for KTS and −0.007 (95% CI −0.035 to 0.03) for Gerdin et al. The NRI+ for each model were −0.235 (−0.37 to −0.116), 0.17 (−0.042 to 0.405), 0.55 (0.47 to 0.65) and 0.22 (0.11 to 0.717), respectively. The NRI− were 0.385 (0.348 to 0.4), −0.059 (−0.476 to −0.005), −0.162 (−0.18 to −0.146) and 0.039 (−0.229 to 0.06), respectively.ConclusionThe findings of this study suggest that there are no substantial differences in discrimination and net reclassification improvement between clinicians and all four clinical prediction models when using 30-day mortality as the outcome of ED trauma triage in adult patients.Trial registration numberClinicalTrials.gov Registry (NCT02838459).

Profile and triage validity of trauma patients triaged green: a prospective cohort study from a secondary care hospital in India

“…The clinicians involved have a minimum of 2 years clinical experience, however, they are neither trained in trauma care as a specialty nor are they necessarily trained in trauma management courses such as Advanced Trauma Life Support. After their initial on-arrival assessment of each patient, the research officers asked the clinicians to categorise the urgency of patients into the aforementioned colour-coded triage groups, 15 henceforth referred to as the clinician’s tacit triage (CTT). The CTT was just based on the clinician’s experiential and intuitive clinical knowledge.…”

Herausforderungen der Digitalisierung in der Traumaversorgung

“…Potenzielle Anwendungen für IA-gestützte Systeme finden sich in 4 klinischen Bereichen: 4 Analyse und Interpretation anamnestischer Daten und Untersuchungsergebnissen [16][17][18][19][20][21], digitaler Algorithmen die Fehlerrate in den ersten 30 min der Schockraumversorgung signifikant reduziert werden kann [26]. Assistenzsysteme unterstützen zudem die Datenerhebung für die innerklinische Triage [19].…”

“…Assistenzsysteme unterstützen zudem die Datenerhebung für die innerklinische Triage [19]. Im Vergleich erwiesen sich "menschliche" und "künstliche" Intelligenz dabei als gleichwertig [20].…”

Fibrinogen; a predictor of injury severity and mortality among patients with traumatic brain injury in Sub-Saharan Africa: a prospective study.

“…(7,8) Evidence from prior studies shows that deaths from trauma can be prevented if adequate and timely identi cation of the problem is done and the appropriate line of management is decided early. (9) In low and middle income settings where there is limited access to prompt investigation modalities for TBI victims, clinicians often nd themselves relying on trauma algorithms, trauma assessment tools and clinical examination ndings to diagnose and direct TBI management. Some of the trauma assessment tools employed in the evaluation of TBI patients include; Abbreviated Injury Score(AIS), Trauma Injury Severity Score (TRISS) and the Glasgow Coma Scale (GCS) speci cally for TBI.…”