Determination of mis-triage in trauma patients: a systematic review

Najafi, Zohre; Abbaszadeh, Abbas; Zakeri, Hossein; Mirhaghi, Amir

doi:10.1007/s00068-019-01097-2

“…Thus, it seems sensible to monitor the accuracy of TTA criteria [6]. Up to the present, a wide and largely varying composition of criteria and definitions have been used to describe correct TTA between studies or to calculate undertriage [12][13][14][15][16]. To suggest a generally acceptable standard to identify patients who, in retrospect, will have or would have correctly benefited from TTA a list of 20 items has been proposed by traumatologists in Germany and Switzerland in a previous publication [17].…”

Section: Introductionmentioning

confidence: 99%

Survey on worldwide trauma team activation requirement

Waydhas

¹

,

Trentzsch²,

Hardcastle

³

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Trauma team activation (TTA) is thought to be essential for advanced and specialized care of very severely injured patients. However, non-specific TTA criteria may result in overtriage that consumes valuable resources or endanger patients in need of TTA secondary to undertriage. Consequently, criterion standard definitions to calculate the accuracy of the various TTA protocols are required for research and quality assurance purposes. Recently, several groups suggested a list of conditions when a trauma team is considered to be essential in the initial care in the emergency room. The objective of the survey was to post hoc identify trauma-related conditions that are thought to require a specialized trauma team that may be widely accepted, independent from the country's income level. Methods A set of questions was developed, centered around the level of agreement with the proposed post hoc criteria to define adequate trauma team activation. The participants gave feedback before they answered the survey to improve the quality of the questions. The finalized survey was conducted using an online tool and a word form. The income per capita of a country was rated according to the World Bank Country and Lending groups. Results The return rate was 76% with a total of 37 countries participating. The agreement with the proposed criteria to define post hoc correct requirements for trauma team activation was more than 75% for 12 of the 20 criteria. The rate of disagreement was low and varied between zero and 13%. The level of agreement was independent from the country's level of income. Conclusions The agreement on criteria to post hoc define correct requirements for trauma team activation appears high and it may be concluded that the proposed criteria could be useful for most countries, independent from their level of income. Nevertheless, more discussions on an international level appear to be warranted to achieve a full consensus to define a universal set of criteria that will allow for quality assessment of over-and undertriage of trauma team activation as well as for the validation of field triage criteria for the most severely injured patients worldwide. Keywords Trauma team • Trauma team activation • Field triage • Overtriage The members of the World-Trauma TAcTIC Study Group mentioned in Acknowledgements section.

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“…This result is above the recommendations of less than 5% as set by the ACSCOT (3). Many European and American studies reported similar or even higher undertriage rate (4,14,15,16). In a comparable health system also bene ting from physician on scene and medical dispatching, French authors reported higher undertriage rate about 18% (7 (17).…”

Section: Discussionmentioning

confidence: 91%

Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry

Benhamed

¹

,

FRATICELLI²,

CLAUSTRE³

et al. 2020

Preprint

0

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BackgroundThe proper prehospital triage and transportation of patients suffering major trauma to lever 1 trauma centers is associated with better outcomes. Hence, emergency medical systems (EMS) aim is to avoid undertriage in these patients. The main objective of this study was to assess the rate and predictors of undertriage in a physician-led prehospital system.MethodsWe conducted an observational multicentric, region-wide, retrospective study based on the RESUVal Trauma-System registry, Rhône-Alpes region, France. All adults assessed by physician-led EMS units, from January 2011 to December 2017 with major trauma (Injury Severity Score (ISS) ≥ 16) were included. We defined the correct-triage group as major trauma patients admitted to a level I trauma center. We performed univariate then multivariate logistic regressions with undertriage as outcome.ResultsA total of 7,110 patients were included in the registry, of whom 2,591 patients with an ISS≥ 16. Among these patients, 320 (12.35%) were undertriaged. Median ISS was 25. In-hospital mortality was 16.45% (n=351/2134). Mid-aged patients (51-65 years old) were associated with a higher risk of undertriage than the others (OR=1.62, 95%CI 1.15-2.28, p=0.01). Factors associated with a lower risk of undertriage were: mechanism (fall or gunshot/stabbing wounds, 0.62, [0.45-0.86], p=0.01 and 0.44, [0.22-0.9], p=0.02, respectively), time on-scene (over 60 minutes, 0.61, [0.38-0.95], p=0.03), prehospital need for endotracheal intubation and ultrasound examination (0.53, [0.39-0.72], p<0.001 and 0.15, [0.08-0.29], p<0.001 respectively). After adjusting for severity, undertriage showed a non-significant tendency toward an increased risk of mortality (1.22, [0.8-1.89], p=0.36).ConclusionsIn our region-wide, physician-led prehospital system, undertriage of major trauma was not rare. The typical profile of undertriaged patients was a mid-aged male suffering from a blunt trauma, without respiratory distress or neurologic impairment, not benefiting from prehospital ultrasound examination and located close to a non-trauma center hospital.

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“…This result is above the recommendations of less than 5% as set by the ACSCOT (3). Many European and American studies reported similar or even higher undertriage rate (4,14,15,16). In a comparable health system also bene ting from physician on scene and medical dispatching, French authors reported higher undertriage rate about 18% (7).…”

Section: Discussionmentioning

confidence: 99%

“…Many de nitions of undertriage exist and one of the most common is based on the Injury severity score (ISS), which is calculated at hospital discharge (4). Using this score, patients are classically considered undertriage if presenting an ISS ≥ 16 and transported to non-level 1 trauma centers.…”

Section: Introductionmentioning

confidence: 99%

“…The American College of Surgeons Committee on Trauma consider an undertriage rate below 5% within an ideal organized trauma system (3). Therefore a recent systematic review reported within international studies an undertriage rates ranging from 1 to 71,9% (4). Few studies have investigated the characteristics of undertriaged patients, in a physician-led prehospital system.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry

Benhamed¹,

Fraticelli²,

Claustre³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

BackgroundThe proper prehospital triage and transportation of patients suffering major trauma to lever 1 trauma centers is associated with better outcomes. Hence, emergency medical systems (EMS) aim is to avoid undertriage in these patients. The main objective of this study was to assess the rate and predictors of undertriage in a physician-led prehospital system.MethodsWe conducted an observational multicentric, region-wide, retrospective study based on the RESUVal Trauma-System registry, Rhône-Alpes region, France. All adults assessed by physician-led EMS units, from January 2011 to December 2017 with major trauma (Injury Severity Score (ISS) ≥ 16) were included. We defined the correct-triage group as major trauma patients admitted to a level I trauma center. We performed univariate then multivariate logistic regressions with undertriage as outcome.ResultsA total of 7,110 patients were included in the registry, of whom 2,591 patients with an ISS≥ 16. Among these patients, 320 (12.35%) were undertriaged. Median ISS was 25. In-hospital mortality was 16.45% (n=351/2134). Mid-aged patients (51-65 years old) were associated with a higher risk of undertriage than the others (OR=1.62, 95%CI 1.15-2.28, p=0.01). Factors associated with a lower risk of undertriage were: mechanism (fall or gunshot/stabbing wounds, 0.62, [0.45-0.86], p=0.01 and 0.44, [0.22-0.9], p=0.02, respectively), time on-scene (over 60 minutes, 0.61, [0.38-0.95], p=0.03), prehospital need for endotracheal intubation and ultrasound examination (0.53, [0.39-0.72], p<0.001 and 0.15, [0.08-0.29], p<0.001 respectively). After adjusting for severity, undertriage showed a non-significant tendency toward an increased risk of mortality (1.22, [0.8-1.89], p=0.36).ConclusionsIn our region-wide, physician-led prehospital system, undertriage of major trauma was not rare. The typical profile of undertriaged patients was a mid-aged male suffering from a blunt trauma, without respiratory distress or neurologic impairment, not benefiting from prehospital ultrasound examination and located close to a non-trauma center hospital.

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Determination of mis-triage in trauma patients: a systematic review

Cited by 32 publications

References 38 publications

Survey on worldwide trauma team activation requirement

Survey on worldwide trauma team activation requirement

Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry

Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry

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