National guideline for the field triage of injured patients: Recommendations of the National Expert Panel on Field Triage, 2021

Newgard, Craig D.; Fischer, Peter; Gestring, Mark L.; Michaels, Holly; Jurkovich, Gregory J.; Lerner, E. Brooke; Fallat, Mary E.; Delbridge, Theodore R.; Brown, Joshua B.; Bulger, Eileen M.

doi:10.1097/ta.0000000000003627

Cited by 103 publications

(72 citation statements)

References 91 publications

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“…A cutoff value of 0.6 has higher sensitivity of 74.0% and acceptable specificity of 51.5%. However, based on the prediction performance, the SIAVPU score has better performance in terms of specificity than sensitivity, which is similar to the national guideline for field triage (18). Therefore, consideration of definite care in trauma centers was given to trauma patients with SIAVPU ≥0.9.…”

Section: Discussionmentioning

confidence: 89%

Prehospital Shock Index Multiplied by Avpu Scale as a Predictor of Clinical Outcomes in Traumatic Injury

Yang

Lin

Liu

et al. 2022

Shock

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Objectives: Many prehospital trauma triage scores have been proposed, but none has emerged as a criterion standard. Therefore, a rapid and accurate tool is necessary for field triage. The shock index (SI) multiplied by the AVPU (Alert, responds to Voice, responds to Pain, Unresponsive) score (SIAVPU) reflected the hemodynamic and neurological conditions through a combination of the SI and AVPU. This study aimed to investigate the prediction performance of SI multiplied by the AVPU and to compare the prediction performance of other prehospital trauma triage scores in a population with traumatic injury. Patients and Methods: This study included 6,156 patients with trauma injury from the Taipei Tzu Chi trauma database. We investigated the accuracy of four scoring systems in predicting mortality, intensive care unit (ICU) admission, and prolonged hospital stay (defined as a duration of hospitalization >14 days). In the subgroup analysis, we also analyzed the effects of age, injury mechanism and severity, underlying diseases, and traumatic brain injury. Results: The predictive accuracy of SIAVPU for mortality, ICU admission, and prolonged hospital stay was significantly higher than that of SI, modified SI, and SI multiplied by age in the traumatic injury population, with an area under the receiver operating characteristic curve of 0.738 for mortality, 0.641 for ICU admission, and 0.606 for prolonged hospital stay. In the subgroup analysis, the prediction accuracy of mortality, ICU admission, and prolonged hospital stay of SIAVPU was also better in patients with younger age, older age, major trauma (Injury Severity Score ≥16), motor vehicle collisions, fall injury, healthy, cardiovascular disease, mixed traumatic brain injury, and isolated traumatic brain injury. The best cutoff levels of SIAVPU score to predict mortality, ICU admission, and total length of stay ≥14 days in trauma injury patients were 0.90, 0.82, and 0.80, with accuracies of 88.56%, 79.84%, and 78.62%, respectively. Conclusions: In conclusion, SIAVPU is a rapid and accurate field triage score with better prediction accuracy for mortality, ICU admission, and prolonged hospital stay than SI, modified SI, and SI multiplied by age in patients with trauma. Patients with SIAVPU ≥0.9 should be considered for the highest-level trauma center available within the geographic constraints of regional trauma systems.

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Section: Discussionmentioning

confidence: 89%

Prehospital Shock Index Multiplied by Avpu Scale as a Predictor of Clinical Outcomes in Traumatic Injury

Yang

Lin

Liu

et al. 2022

Shock

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“…The results reflected standard trauma activation criteria may not be adequate to identify the at-risk severely injured trauma patient. Although our results showed a high percentage of undertriage patients up to 6.9% (793 patients) compared to the suggestion of field triage guidelines, undertriage patients also received the definite care as the normal activated group (ICU admission: 66.5 v.s 6.78% and surgical intervention: 37.6% vs. 39.1%) [ 22 ]. In the undertriage group, the isolated TBI patients and geriatric patients were two major groups accounting for up to 56.4% (447/793 patients) and 46.5% (396/793 patients).…”

Section: Discussionmentioning

confidence: 92%

“…A high proportion of undertriage and overtriage may decrease the effect of TTA. Current guidelines (AAST-COT) recommend an acceptable undertriage rate of less than 5% and an overtriage rate of 25–35% [ 22 ]. In our criteria, the undertriage rate (non-TTA with ISS ≥ 16) was 6.9% (793/11466 in non-TTA), and the overtriage rate (TTA with ISS < 16) was 32.9% (158/480 in TTA).…”

Section: Discussionmentioning

confidence: 99%

Association of In-Hospital Mortality and Trauma Team Activation: A 10-Year Study

et al. 2022

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Background: Early trauma team activation (TTA) may improve clinical outcomes through early diagnosis and timely intervention by a dedicated multidisciplinary team. Controversy seems to exist about the effect of establishing trauma team systems in traumatic injury populations. Our aim was to identify factors that may be associated with clinical outcomes in trauma injury and to investigate the effect of trauma team activation. Method: This retrospective descriptive study included all traumatic patients from the Taipei Tzu Chi Hospital Trauma Database. All prehospital vital signs, management, injury type, injury mechanisms, hospitalization history, and clinical outcomes were analyzed, and multivariable logistic regression was used to investigate the association between trauma team activation and clinical outcomes. Subgroups of TTA in minor injury and non-TTA in major injury were also analyzed. Result: In this study, a total of 11,946 patients were included, of which 10,831 (90.7%) patients were minor injury (ISS < 16), and 1115 (9.3%) patients were major injury (ISS ≥ 16). In the minor injury population, TTA had a higher intensive care unit (ICU) admission rate, operation rate, re-operation rate, and prolonged total length of stay (LOS). In the major injury population, TTA had a higher mortality rate, prolonged total LOS, and prolonged ICU LOS. After adjusting for mechanism of injury and injury severity, there was no association between in-hospital mortality and TTA, compared with the non-TTA group. However, the TTA group had a higher risk of ICU admission, prolonged ICU LOS, and prolonged total LOS. The subgroup analysis showed trauma team activation had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Conclusions: We found there was no significant association between in-hospital mortality and TTA. However, in the TTA group, there was a higher risk of ICU admission, prolonged total, LOS, and prolonged ICU LOS. In the subgroup analysis, TTA had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Our results reflect TTA-criteria-selected patients with greater ISS and a high risk of mortality.

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“…Comprehensive guidelines for field triage of injured patients support the transport of patients within regionalized trauma systems. 23,24 Since management of more severely injured patients and/or those requiring specialized care at Level 1 trauma centers has been shown to be associated with improved survival rates, 25 early identification of patients with severe injury and triage to higher levels of care would result in improved outcomes. Because TBI accounts for a substantial proportion of trauma deaths and is among the more time-sensitive injuries, early triage decisions in the field and at the initial treatment facility may have disproportionate impact on survival and older adult patients may be especially vulnerable to delays in care.…”

Section: Discussionmentioning

confidence: 99%

The burden of geriatric traumatic brain injury on trauma systems: Analysis of 348,800 Medicare inpatient claims

Fakhry

Shen

Garland

et al. 2022

J American Geriatrics Society

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Background Traumatic brain injury (TBI) is a leading cause of death and disability in older adults. The aim of this study was to characterize the burden of TBI in older adults by describing demographics, care location, diagnoses, outcomes, and payments in this high‐risk group. Methods Using 2016–2019 Centers for Medicare & Medicaid Services (CMS) Inpatient Standard Analytical Files (IPSAF), patients >65 years with TBI (>1 injury ICD‐10 starting with “S06”) were selected. Trauma center levels were linked to the IPSAF file via American Hospital Association Hospital Provider ID and fuzzy‐string matching. Patient variables were compared across trauma center levels. Results Three hundred forty‐eight thousand eight hundred inpatients (50.4% female; 87.1% white) from 2963 US hospitals were included. Level I/II trauma centers treated 66.9% of patients; non‐trauma centers treated 21.5%. Overall inter‐facility transfer rate was 19.2%; in Level I/II trauma centers transfers‐in represented 23.3% of admissions. Significant TBI (Head AIS ≥3) was present in 70.0%. Most frequent diagnoses were subdural hemorrhage (56.6%) and subarachnoid hemorrhage (30.6%). Neurosurgical operations were performed in 10.9% of patients and operative rates were similar regardless of center level. Total unadjusted mortality for the sample was 13.9%, with a mortality of 8.1% for those who expired in‐hospital, and an additional 5.8% for those discharged to hospice. Medicare payments totaled $4.91B, with the majority (73.4%) going to Level I/II trauma centers. Conclusions This study fills a gap in TBI research by demonstrating that although the majority of older adult TBI patients in the United States receive care at Level I/II trauma centers, a substantial percentage are managed at other facilities, despite 1 in 10 requiring neurosurgical operation regardless of level of trauma center. This analysis provides preliminary data on the function of regionalized trauma care for older adult TBI care. Future studies assessing the efficacy of early care guidelines in this population are warranted.

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National guideline for the field triage of injured patients: Recommendations of the National Expert Panel on Field Triage, 2021

Abstract: This work details the process of developing the updated field triage guideline, the supporting evidence, and the final version of the 2021 National Guideline for the Field Triage of Injured Patients.

Cited by 103 publications

References 91 publications

Prehospital Shock Index Multiplied by Avpu Scale as a Predictor of Clinical Outcomes in Traumatic Injury

Prehospital Shock Index Multiplied by Avpu Scale as a Predictor of Clinical Outcomes in Traumatic Injury

Association of In-Hospital Mortality and Trauma Team Activation: A 10-Year Study

The burden of geriatric traumatic brain injury on trauma systems: Analysis of 348,800 Medicare inpatient claims

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