Evaluating performance of the Revised Trauma Score as a triage instrument in the prehospital setting

Roorda, J.; Beeck, Ed F. van; Stapert, J. W. J. L.; Wolde, W. ten

doi:10.1016/0020-1383(95)00218-9

Cited by 37 publications

(30 citation statements)

References 12 publications

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“…It is of interest to know which trauma scoring method was a more accurate predictor for this population for triaging purposes given inconclusive data globally (Gabbe, Cameron, & Finch, 2003;Roorda, van Beeck, Stapert, & ten Wolde, 1996;Savitsky & Rodenberg, 1995). Our bivariate analyses show that the RTS is not a better predictor compared to GCS for this population however the results of the multivariable analyses give slightly better results with RTS as a predictor compared to GCS.…”

Section: Discussionmentioning

confidence: 99%

26 Evaluating access to prehospital care for traumatic brain injury patients in a resource limited setting: focus on prehospital transport

2015

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Prehospital factors recorded include time, distance and cost. Multivariable regression analyses evaluated the effect of prehospital factors on unfavourable patient TBI outcome, in-hospital factors and demographics were controlled for. Unfavourable outcome was defined as Glasgow Outcome Score<5 on discharge or death.RESULTS: Road traffic injuries were the most common mechanism of injury (67.1%). The majority of patients were referred from other facilities in and around the region (62.3%), with 23% from the local public hospital. There was no evidence of prehospital care available in this region. Average prehospital duration was more than 1 hour, a third of this was spent in prehospital transit for a majority of the patients. A minority usedAmbulances. Predictors of unfavourable outcome (GOS<5) were: prehospital time greater than 60 minutes, multiple physical transfers during the prehospital course and being referred from another hospital.v CONCLUSION: The lack of prehospital care calls for further research into prehospital interventions for this setting. Further analysis should be conducted with a larger sample size to increase accuracy of the findings.vi

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Section: Discussionmentioning

confidence: 99%

26 Evaluating access to prehospital care for traumatic brain injury patients in a resource limited setting: focus on prehospital transport

2015

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“…A number of studies have reported the inability to collect the values necessary for the RTS in all cases with missing data ranging from 3% to 28%, [4][5][6][7][8][9][10][11] leading to a variety of mostly unvalidated methods to compensate for the loss of information, or case exclusion. These practical limitations result in a situation in which the TRISS cannot be calculated for a subset of patients (usually the most severely injured), reducing its usefulness as a standard component of trauma registries and surveillance systems.…”

Section: Components Of Trissmentioning

confidence: 99%

TRISS: Does It Get Better than This?

Gabbe

Cameron

Wolfe

2004

Academic Emergency Medicine

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The Trauma and Injury Severity Scoring (TRISS) system was developed in the 1980s to improve the prediction of patient outcomes following trauma through the use of physiological and anatomical criteria. The TRISS is used for a number of purposes, including quantifying the severity of injury of a patient population, calculating the probability of survival of patients for identification of cases for peer review, and comparing the death or survival rates of different populations/hospitals. Despite the advancements in trauma care, improved statistical techniques, and the identification of numerous limitations of TRISS, it continues to be the most commonly used tool for judging hospital performance and monitoring trauma death rates. This article critically evaluates the development, structure, and practical use of TRISS to determine its value in the current trauma environment. Limitations of TRISS are discussed and suggestions are made for the future development of trauma prediction tools.

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“…Previous studies have shown that a lowered RTS can recognize severe trauma victims, with a sensitivity ranging between 60% and 80%. A similar study conducted in the Netherlands found lower results, ranging between 40% and 60% [17]. This difference is possibly seen because of the lower prevalence of trauma in our country due to traffic conditions, for example a high traffic load on the (high) way's due to demographic characteristics resulting in a relatively low average vehicle speed compared with the surrounding countries like Germany and Belgium [18,19].…”

Section: Discussionmentioning

confidence: 54%

Cancellations of (helicopter transported) – Mobile Medical Team dispatches in the Netherlands

2010

TVTR

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Background The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched. The aim of this study was to assess the cancellation rate and the noncompliant dispatches of our MMT and to identify factors associated with this form of primary overtriage. Methods By retrospective analysis of all MMT dispatches in the period from 1 July 2006 till 31 December 2006 using chart review, we conducted a consecutive case review of 605 dispatches. Four hundred and sixty seven of these were included for our study, collecting data related to prehospital triage, patient's condition on-scene and hospital course. Results Average age was 35.9 years; the majority of the patients were male (65.3%). Four hundred and thirty patients were victims of trauma, sustaining injuries in most cases from blunt trauma (89.3%). After being dispatched, the MMT was cancelled 203 times (43.5%). Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p<0.001). All dispatches were evaluated by using the MMT-dispatch criteria and mission appropriateness criteria. Almost 26% of all dispatches were neither appropriate, nor met the dispatch criteria. Fourteen missions were appropriate, but did not meet the dispatch criteria. The remaining 318 dispatches had met the dispatch criteria, of which 135 Surg (2010) 395:737-745 DOI 10.1007 (30.3%) were also appropriate. The calculated additional costs of the cancelled dispatches summed up to a total of € 34,448, amounting to 2.2% of the total MMT costs during the study period. Conclusion In our trauma system, the MMT dispatches are involved with high rates of overtriage. After being dispatched, the MMT is cancelled in almost 50% of all cases. We found an undertriage rate of 4%, which we think is acceptable. All cancellations were justified. The additional costs of the cancelled missions were within an acceptable range. According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to nonacceptable levels.

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Evaluating performance of the Revised Trauma Score as a triage instrument in the prehospital setting

Cited by 37 publications

References 12 publications

26 Evaluating access to prehospital care for traumatic brain injury patients in a resource limited setting: focus on prehospital transport

26 Evaluating access to prehospital care for traumatic brain injury patients in a resource limited setting: focus on prehospital transport

TRISS: Does It Get Better than This?

Cancellations of (helicopter transported) – Mobile Medical Team dispatches in the Netherlands

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