Individual risk factors predictive of major trauma in pre-hospital injured older patients: a systematic review

Pandor, Abdullah; Fuller, Gordon; Essat, Munira; Sabir, L.; Holt, Chris; Woods, Helen Buckley; Chatha, Hridesh

doi:10.29045/14784726.2022.03.6.4.26

British Paramedic Journal

2022

DOI: 10.29045/14784726.2022.03.6.4.26

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Individual risk factors predictive of major trauma in pre-hospital injured older patients: a systematic review

Abdullah Pandor

Gordon Fuller

Munira Essat

et al.

Abstract: Background: Older adults with major trauma are frequently under-triaged, increasing the risk of preventable morbidity and mortality. The aim of this systematic review was to identify which individual risk factors and predictors are likely to increase the risk of major trauma in elderly patients presenting to emergency medical services (EMS) following injury, to inform future elderly triage tool development.Methods: Several electronic databases (including Medline, EMBASE, CINAHL and the Cochrane Library) were … Show more

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2024

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Cited by 3 publications

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Trauma team activation criteria for potential major trauma in the adult population: a narrative review

Garrido Callén,

Pérez Torres,

Vasco Castaño

et al. 2024

Emerg Crit Care Med

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Traumatic disease is a common cause of death and disability in the young population. The presence of a trauma team ensures the quality of patient management, thus improving patient outcomes. Therefore, triage is an essential part of trauma care, especially for potential major trauma patients, who present significant challenges due to the lack of universal and centralized criteria. This narrative review aimed to present an overview of the main studies conducted thus far, focusing on the screening of adult patients in both prehospital and in-hospital settings, along with the latest guidelines published in 2021. Our approach involved a nonsystematic literature review, with a particular emphasis on systematic reviews and meta-analyses of observational studies published in the PubMed, Embase, and Cochrane databases. We analyzed the different tools proposed for patient screening and incorporated them into our protocol for triaging potential trauma patients who could benefit from early trauma team activation. In conclusion, our review underscores the importance of incorporating accurate physiological criteria and suspected injury patterns into a trauma team activation protocol. We also highlight the ongoing challenges in refining the mechanistic aspects of trauma and special considerations. Moving forward, continued research with new machine learning models and collaboration among trauma experts may be crucial for enhancing the precision and effectiveness of trauma triage, ultimately leading to improved patient outcomes and optimal resource allocation.

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Trauma team activation criteria for potential major trauma in the adult population: a narrative review

Garrido Callén,

Pérez Torres,

Vasco Castaño

et al. 2024

Emerg Crit Care Med

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‘Endless variation on a theme’: a document analysis of international and UK major trauma triage tools

Fuller,

Holt,

Keating

et al. 2024

British Paramedic Journal

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Introduction: Triage tools are used within trauma networks to identify which injured patients should be bypassed and pre-alerted to major trauma centres. Despite the importance of treating the ‘right patient in the right place at the right time’, there has been no consensus on triage tool structure or content. This study aimed to identify, collate, review, summarise and recognise patterns across established major trauma triage tools.Methods: UK and international triage tools used between 2012 and 2021 were identified through literature review and correspondence with trauma networks. A conceptual content analysis was then undertaken using an inductive codebook, comprising concepts of triage tool structure, intended population, inclusion criteria and included variables and thresholds. Thematic analysis was also performed to identify higher-level patterns within the data, with emerging patterns becoming categories for analysis. A narrative synthesis of findings was then undertaken.Results: In total, 53 major trauma tools were identified, comprising 19 UK tools and 35 published international tools. Most triage tools (n = 42/53, 80%) were developed by expert opinion, were paper based and shared a common structure of multiple domains, with constituent triage predictors assessed in parallel. A minority of tools were statistically derived prediction models, operationalised either as simple scores (n = 10, 19%) or as an electronic application (n = 1, 1%). Overall, 173 distinct triage variables were used, with the median number of constituent triage variables per triage tool being 19 (range 3‐31). Four distinct patterns of triage tools were identified during thematic analysis, which differed in terms of format, number of triage variables, thresholds, scope for clinical judgement and relative diagnostic accuracy.Conclusion: Many diverse major trauma triage tools were identified, with no consensus in format, structure or content. Quantification of constituent variables and identification of distinct categories of triage tools may guide the design of future triage tools.

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Major Trauma Triage Tool Study (MATTS) expert consensus-derived injury assessment tool

Fuller,

Howes,

Mackenzie

et al. 2024

British Paramedic Journal

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Introduction: Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of triage tools to select patients for bypass to MTCs. A standardised national triage tool may improve triage accuracy, cost-effectiveness and the reproducibility of decision-making.Methods: We conducted an expert consensus process to derive and develop a major trauma triage tool for use in English trauma networks. A web-based Delphi survey was conducted to identify and confirm candidate triage tool predictors of major trauma. Facilitated roundtable consensus meetings were convened to confirm the proposed triage tool’s purpose, target diagnostic threshold, scope, intended population and structure, as well as the individual triage tool predictors and cut points. Public and patient involvement (PPI) focus groups were held to ensure triage tool acceptability to service users.Results: The Delphi survey reached consensus on nine triage variables in two domains, from 109 candidate variables after three rounds. Following a review of the relevant evidence during the consensus meetings, iterative rounds of discussion achieved consensus on the following aspects of the triage tool: reference standard, scope, target diagnostic accuracy and intended population. A three-step tool comprising physiology, anatomical injury and clinical judgement domains, with triage variables assessed in parallel, was recommended. The triage tool was received favourably by PPI focus groups.Conclusions: This paper presents a new expert consensus derived major trauma triage tool with defined purpose, scope, intended population, structure, constituent variables, variable definitions and thresholds. Prospective evaluation is required to determine clinical and cost-effectiveness, acceptability and usability.

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Individual risk factors predictive of major trauma in pre-hospital injured older patients: a systematic review

Cited by 3 publications

References 46 publications

Trauma team activation criteria for potential major trauma in the adult population: a narrative review

Trauma team activation criteria for potential major trauma in the adult population: a narrative review

‘Endless variation on a theme’: a document analysis of international and UK major trauma triage tools

Major Trauma Triage Tool Study (MATTS) expert consensus-derived injury assessment tool

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